Repeal and saving.

1. (1) The Goa Regularisation of Unauthorized Construction Ordinance, 2016 (Ordinance No. 2 of 2016) is hereby repealed.
2. (2) Notwithstanding such repeal, anything done or any action taken under the said Ordinance shall be deemed to have been done or taken under this Act. FORM I [See section 3(1)] Application cum self declaration for regularisation of unauthorized construction To, The ........................... Having Camp office at ............................., Authorised Officer For the Taluka of ............., District .................... Goa. Sub: Request for regularisation of unauthorized construction. Sir/Madam, In pursuance to the .............................................Act, 2016, I, Shri ..................................................son/daughter/wife of ............................., major in age, (occupation), ................................. residing at ................................ , Goa, do hereby request your good office to kindly consider my request to regularise the unauthorized construction done by me the details of which along with my declaration are given herein below:— (All details to be filled in capital letters only) 1. Name of the applicant: 2. Postal address of the applicant: 3. Brief description of the unauthorized construction: (type of structure: Residential/Commercial/ /Residential cum commercial/institutional) 4. Survey No. /Sub division No: 5. Name of the Revenue Village and Taluka: 6. Details of construction (tick mark the appropriate option) Independent structure: Expansion of existing structure:
   • (a) Category of the structure:
   • (b) Details of present usage:

Personal dwelling Leased on rent

Store –room

Other (specify)

1. (c) Whether in one’s property or joint or other:
2. (d) If not one’s property, whether NOC of owner/co-owner is attached:
3. (e) Precise plinth area of the construction in square meters: 7. Details of amount paid:—
4. (a) Total amount paid:
5. (b) Challan/DD/PO No.:
6. (c) Whether entire or 50% paid: 8. Details of pending disputes, if any:—
7. (a) Before which authority/court:
8. (b) Case number:
9. (c) Stage of hearing:
10. (d) any injunction /prohibitory order are issued. 9. Structure Stability Certificate (if building has floors)
11. (a) Enclosed / not enclosed:
12. (b) issued by:
13. (c) Dates of Inspection being carried out and report prepared on: I do hereby undertake and declare that all the information given hereinabove is true and correct and that nothing therein is concealed misrepresented or wrongly mentioned.

I further declare and undertake that I am aware that any of the above mentioned information provided by me if found to be incorrect, false or misrepresented, then the regularization of the construction, if ordered by the authorised officer shall stand automatically revoked and I shall be under bounden duty to remove the said construction immediately at my own cost.

I also declare that the said construction is not within any of the prohibited areas/sites as mentioned in the sub-

section (5) of Section 3. I further undertake that I am in no dues to Government or local bodies and that I have paid all my dues. I further declare that I am fully responsible for any wrong declaration given hereinabove or in any other statement that may be required to be given by me for processing my request. Enclosed: - (1) Sketch showing dimension of the structure.

1. (2) Receipt of amount paid.
2. (3) Documents relied on viz...... 4) Any other enclosure.................. Signature of the Applicant/Deponent Name of the Applicant