Form LRA 67 (r.

80(1))
REPUBLIC OF KENYA

THE LAND REGISTRATION ACT

THE LAND REGISTRATION (GENERAL) REGULATIONS, 2017

Date Received Presentation Book Official Fees Paid

………………… No…………………. Kshs.

CAUTION

TITLE NUMBER: MUTOMO /MUTINI/144

Date of Caution 7th SEPTEMBER,2023

The Cautioner: VERONICA KISANGAU
ID/Passport No. 3173098
Registration No of the
Cautioner (if any)
Address of the
Cautioner (within C/O MWATUNGE PRIMARY SCHOOL
Kenya for service of
Notice).
The Proprietor: KISANGAU KATANA
ID/Passport N/A
Registration No. of the
Proprietor (if any)
PIN Number.
Citizenship/Place of KENYAN
registration.
Address of the N/A
Proprietor (within
Kenya for service of
notice).
Interest Claimed MATRIMONIAL PROPERTY (The cautioner is married to the
proprietor under Kamba traditional laws and Traditions)
Extent or Scope of the ABSOLUTELY
Caution
(Absolutely/Subject to
the Interest of the
Cautioner)
1. The Cautioner HEREBY APPLIES for registration of a Caution over the above Title to the
extent or scope stated above.
2. The Cautioner forbid the registration of dealings and the making of entries in the register
relating to the Title to the extent or scope of the Caution without the Cautioner’s consent
until this Caution has been withdrawn by the Cautioner or removed by order of the Court or
the Registrar.
3. The Cautioner hereby attaches the following documents in support of the application*: -
I. Copy of Title deed.
II. Copy of ID Card

IN WITNESS the Cautioner has signed this Caution.

EXECUTION:
SIGNED by the Cautioner in
the presence of:-

Coloured
Photograph

ID/No. 3173098
PIN No. …………………………….
Signature……………………………..

Certificate of Verification
I CERTIFY that the above-named VERONICA KISANGAU appeared before me on the
7th day of September, 2023 and being known to me acknowledge the above signatures or
marks to be his/hers and that he/she had freely and voluntarily executed this instrument and
understood its contents.

…………..……………………..
Signature and Designation of
Person Certifying**

REGISTERED and SEALED this …… day of …………………. 20……

seal…………………………………..
LAND REGISTRAR
Name:
Signature:

(P.T.O)
*Copies of Sale Agreement, Letters of Administration, Letter of Offer etc

STATUTORY DECLARATION

I, FESTUS MNENZI SHEGHU (in support of this caution) do hereby sincerely declare as
follows: -

1. THAT I am a Male adult of sound mind and holder of Kenya National Identity Card No.
12547581 hence competent to make this Declaration

2. THAT the parcel of Land being TAITA TAVETA/MODAMBOGHO/5383 registered in

the name of DONALD RIGHA MTOTO was initially owned by my deceased mother
MARY MALEMBA SHEGHU since 1st July, 1996.

3. THAT after Adjudication the parcel of land without our consent and/or knowledge, the
parcel of land was registered in the name of DONALD RIGHA MTOTO.
4. THAT since I intend to commence legal proceedings against the registered proprietor and
as such, lodge this caution to bar any dealings until such a time when I shall remove it to
await the outcome of a case in intend to file in court.

I make this declaration conscientiously believing the same to be true and according to the Oaths
and Statutory Declaration Act.

DECLARED before me at VOI

By FESTUS MNENZI SHEGHU …………………………

On the ………………day of………………. 2023

…………………………
Signature of Advocate
Or Land Registrar