AFFIDAVIT

Declaration–cum–undertaking
( to be submitted where the property tax not yet levied by the local body)

(To be sgned and submitted by the Owner, Builder/Developer/Construction

Firm and Licensed Technical Personnel)
(Notarized undertaking to be executed on Rs.100/- N.J. Stamp Paper)

This Declaration cum undertaking is executed on this………………………day of

………………… 20.. at ……………………………………………,(ULB) jointly by the Owner,
Builder/Developer/Construction Firm and the Licensed Technical Personnel.

We, Sri …………….., S/o……………………, R/o…………..·(Owner/Owners) and

Sri…………………. S/o………………….(LTP – License No. …..) have applied for
regularization of Building in the premises situated and its details as given
below.

Name of the owner

/Owners
T.S/NTS/D.No/R.S.No.
Door No.(if any)
Locality
Street
Plot area
No. of floors in Cellar/ Stilt/ GF/1st /2nd /3rd / 4th
existence /…….
No. of floors applied for
regularization
BUA (in each floor
wise)
Existing / Intended
usage of the building
(floor wise)
Old tax receipt (PT
/VLT) details
 Completion date of the
building

The above said construction with the specification mentioned is

within the purview of ‘ The Andhra Pradesh Regularization and Penalization
of Buildings Constructed unauthorisedly and in deviation to the sanctioned
plan Rules,2019 and declared that the above said structure / building
construction was completed prior to 31.08.2018.

If any misrepresentation of the above fact identified by the

authorities we will be held responsible and abide with the actions initiated by
the Authorities including demolition / prosecution besides cancellation of the
proceedings issued under BPS,2019 / cancellation of License (LTP) without
any further notice and we should not claim any compensation to the actions
initiated by the authorities.

1. Signature of the owner/s

a)
b)

2. LTP

Witness
1.

2.
Sworn and signed before me on this ……………… day…..2019 in the presence of above
witness.
PUBLIC NOTARY