10 ul 12, 2B. coer REPUBLIC OF BOTSWANA APPLICATION FOR COMMON LAW LAND RIGHTS, (Under Section 24 of the Tribal Land Act) Full names of applicant. Postal Address... sow Tel: No. Date of Birth... 4 Age. Are you a citizen of Botswana? ‘Yes/No* LD, NO.eessssese Passport No. nee Residence Permit No... Marital Status: Married/Single/Divorced/Separated/Widowed* If married, name of spouse. ‘Name of place where plot applied f01 18... Present use of the plot applied for. Size of plot applied for... Is the plot applied for debushed? Yes/No* Description of lease sought, length of lease and purpose. A sketch plan showing you p buildings, etc., must be attached to the application form, List any other land rights you possess in Botswana and state where they are ‘Are all the sites mentioned above developed? If no, give reasons... “YesiNo* 5. Man/Woman* applying for and its location relative to roads, otherList in full, names of people whom you have consulted who hold land bordering the plot for which you are applying.. In case of companies, Certificate of Incorporation and Shareholding should be attached to the application form. In accordance with the Second Schedule of the Tribal Land Act, (January 19, 1970) a fee of P 5,00 is charged for applications under section 24 of the Act. Receipt NOveorsnuesinnumininnrninenaninenennanenes DAE a “(Signature of Official) Lass sas snsonetate that the above information is complete and (full name of applicant) correct. I understand that any statement or representation that I make, whether explicit or implied, which I know or reasonably ought to have known was untrue, for the purpose of obtaining a grant of land, ot for the purpose of obtaining any benefit shall result in the rejection of the application andior prosecution and/or forefeiture of the plot if already granted to me, “(Siganture of Applicant) (Date) RECOMMENDATION BY LAND OVERSEER L, - a - confirm that the plot (full name of Land overseer) applied for above: (a) has been allocated/not been allocated.* (b) _itsallocation will interfere/not interfere with other people’s rights (c) the proposed use will/will not conflict with the land use in the area” “(Sienature of Land overseer) Date) “Delete words which do not apply