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REMAINING BLCOKS IN THE STATE 1.00 1.50 1.50 FORM I Declaration Form (Under Section 9) Presented to _______________________________________________________________ Declaration by___________________________Son of___________________________ ___________________,Village_________________,Tehsil_______________________ District____________________under section 9 of Haryana Ceiling on Land Holdings Act, 1972, regarding particulars of land owned by him and his family and section of permissible area for him and his family members. PART A Details of family members Sr.No. Name Age declarant Relationship Permissible Remarks with the area in terms of ‗C‘ category land (a) Primary Unit 21.8 hectares (1) (2) (3) (4) (5) (b) Additional (i.e. minor children in addition to the above 3 excepting members married minor daughters) (6) (7) (8) (9) (10) (c) Separate Unit (i.e. adult sons living with their parents or either of them, in case of death of any such son, his widow/children) (1) (2) (3) (4) (5) PART B Details of all land held by the members of the family as landowners, tenants or mortgagees with possession or partly in one capacity or partly in another Serial No. 1 Name Father’s 2 3 Date and mode of acquisition, i.e.by inheri - tance / purchase 4 Approxi mate date of mutation 5 A Category Land 6 AA Cate gory Land 7 B Category Land 8 C Cate gory Land 9 Remarks 10 (a) As landowners (i) (ii) (iii) (iv) (v) (vi) (i) (ii) (iii) (iv) (v) (vi) (i) (ii) (iii) (iv) (v) (vi) (b) As tenants (c) As mortgagees PART C (i) Valuation of all types of land held by all the members of the family (in terms of C Category Land) and (ii) the calculation of extent of permissible area for all members of the family. Valuation of land Extent of permissible area for (Kanals in terms of C category Land) Primary Unit of family Additional members Separate Unit Total area (in Kanals) Name Area Name Area Name Area (In Kanals) (In Kanals) (In Kanals) (i) (Total) Kanals under column (6) of Part B (Total Kanals) x 3= (ii) (Total) Kanals under column (7) of Part B (Total Kanals) x 12 ----- = 5 (iii) (Total) Kanals under column (8) of Part B (Total Kanals) x 2= (iv) (Total) Kanals under column (9) of Part B (Total Kanals) x 1= PART D Details of land claimed / selection of ‗and for retention as permissible area Category of land permissible / selected Part I A Category AA Category Land B Category Land C Category Land Total area to be selected Remarks Land in terms of ‗C‘ Category Land Khasra Area Valu- Khasra Area Valu- Khasra Area Valu- Khasra Area Valu- Khasra Area Valu- No. (in ation No. (in ation No. (in ation No. (in ation No. (in ation Kanals) of Kanals) of Kanals) of Kanals) of Kanals) of land land land land land X3 X2 X1 X12 5 Part II (i) Area held by landowner on 30.7.1958: (ii) Permissible area on 30.7.1958 under A.K.M the Acts (The Punjab Security of Land Tenures Act, 1953/ The Pepsu Tenancy and Agricultural Lands Act, 1955.) indicated below: (iii) Area of land sold/transferred, if any, between 30.07.1958 and 24.1.1971 PART E (Details of area offered as surplus) A Category Land AA Category Land B Category Land C Category Land Reamarks Khasra No. Area (in Kanals) Valu ation of land Khasra No. Area (in Kanals) Valu ation of land Khasra No. Area (in Kanals) Valu ation of land Khasra No. Area (in Kanals) Valu ation of land Kha sra No. Area (in Kan als) Valu - ation of land Signature of the declarant I, _________________________________ son of _________________________________ of village _______________________________, Tehsil________________________,District __________________________hereby solemnly declare and affirm that the particulars given by me in this declaration are true to the best of my knowledge and belief and that nothing. Signature of the declarant ATTESTED Certified that the above declaration was made on solemn affirmation before me by_______________________________________ or has been read out by me to Shri __________________________ Son of ______________________________ resident of village ____________________, Tehsil___________________________ District____________________, this ______________ day of _________ 19 at____________ Dated :_______________ Magistrate 1st Class / Oath Commissioner at ________________________________ Certified by Prescribed Authority Certified; (i) that this form has been entered at Serial No._____________ of the register maintained for the purpose, and (ii) that a duly signed receipt has been issued to the declarant. Signature of the declaration in token of having obtained the receipt. Prescribed Authority FORM II Declaration Form (Under Section 10) Prepared by Shri______________________Tehsildar_________________, District _____________________________ in respect of the land held by Shri______________________ of village_____________________ Tehsil ________________District_______________. PART A Details of family members Sr. Name Age Relationship Remarks No. with the declarant (a) Primary Unit (1) (2) (3) (4) (5) (b) Additional Members (i.e. minor children in addition to the above excepting married minor daughters). (6) (7) (8) (9) (c) Separate Unit (i.e. adult sons in case of death of any such son, his widow/ Children) (1) (2) (3) (4) PART B Details of all land held by the members of the family as landowners, tenants or mortgagees with possession or Partly in one capacity, or partly in another Serial No. Name Father’s Date and mode of acquisition i.e. by inheri trance/purchase Approxi mate date of mutat ion A Category Land AA Category Land B Category Land C Category Land Remarks 1 2 3 4 5 6 7 8 9 10 (a) As landowners (i) (ii) (iii) (iv) (v) (vi) (b) As tenants (i) (ii) (iii) (iv) (v) (vi) (c) As mortgagees (i) (ii) (iii) (iv) (v) (vi) PART C (i) Valuation of all types of land held by all the members of the family (in terms of C Category Land) and (ii) the calculation of extent of permissible area for all members of the family. Valuation of land Extent of permissible area for (Kanals in terms of C category Land) Primary Unit of family Name Area (In Kanals) Additional members Name Area (In Kanals) Separate Unit Name Area (In Kanals) Total area (in Kanals) (i) (Total) Kanals under column (6) of Part B (Total Kanals) x 3= (ii) (Total) Kanals under column (7) of Part B (Total Kanals) x 12 ----- = (iii) 5 (Total) Kanals under column (8) of Part B (Total Kanals) x 2= (iv) (Total) Kanals under column (9) of Part B (Total Kanals) x 1= FORM III (Under Section 10) NOTICE A copy of the statement prepared under Section 10 of the Haryana Ceiling on Land Holdings Act, 1972 and pertaining to the land owned or held by you, as known at the moment, is sent herewith, for your information You may appear personally or by duly authorised agent before the undersigned on _____________ at__________ and state as to why surplus land be not determined under the Act on the basis of this statement. Be it noted that in case you fail to appear on the said date and time, an exparte decision would be taken. Prescribed Authority, Dated___________________ Designation_______________________ Place ___________________ Address__________________________ FORM IV (Under Section 11) Statement showing the particular of land of a landowner as required under Section 11 of the Haryana Ceiling on Land Holdings Act, 1972 Note: - Figures wherever required to be given in this form should be in English numerals. PART A Land held by the Family Head of the family -(1) Other Members: (1) (2) (3) (4) (5) Tehsil Location of land Village Qila No. Khasra No, Additional-Land held by any person being treated as separate unit Tehsil Location of land Village Qila No. Khasra No, PART B Area permissible of the Details of the Land Area permissible to Separate Details of Land Remarks Family Unit Village_____________Tehsil___________Name____________ Village__________Tehsil______Name___________ Qila No. Khasra No. Qila No. Khasra No PART C Details of the Land declared surplus Tehsil Village Qila No. Khasra No. Prescribed Authority____________________________________ Designation_____________________________________________ Address________________________________________________ Total Area = Regd. / A.D. No._____________________________Dated__________________________ Office of the_____________________________________________________ (Prescribed Authority) A copy is forwarded to Shri__________________________, son of _______________________resident of village______________, Tehsil____________________________, and District_____________________for necessary action under Section 11(2) of the Haryana Ceiling on Land Holdings Act, 1972. Signature: Prescribed Authority____________________________________ Designation___________________________________________ Address______________________________________________ No.____________________________Dated_______________________ A Copy in triplicate is forwarded to the Tehsildar as required under Section 11(2) of the Haryana Ceiling on Land Holdings Act,