SCHEDULE

(see section 5 (1) )

Declaration under sub-section(l) of section 5.

I……………………(aged………………years) residing at…………………..being desirous of availing myself of financial assistance from the……………………..Bank……………make this declaration as required by section 5(1) of the Gujarat Agricultural Credit (Provision of Facilities) Act, 1979, that I…………………own the land I have interest as a tenant in the land, in the area specified below and I hereby create a charge on the said land/interest in the said land, in favour of the Bank for securing the financial assistance which the bank may give and for all future assistance, if any, which the bank may give to me together with interest and costs and expenses thereon.

Name of Name of Name of Survey No. Village Taluka District City Survey No. Boundaries Areas Plot No. Plot Hissa, South North Hectares

No. East West

Assessment Approximate Encumbrances, if any

Remarks --------------------Value----------------------------------------------------------------------------------- if any Rupees paise

Nature When created

Amount

In witness whereof I, Shri…………………………………………………… hereunder set my hand this……………………………………………day of……………………………. in the year one thousand nine hundred and……………………………………………………………………

Witness

Signed and delivered by the above named in the presence of-

(1)

(2)

Signature of the declarant,

Attested by :

Forwarded with compliments to the Village Accountant or other designated revenue officer with a request to include the particlulars of the charge………………………created under the declaration in the Record of Rights and to return to the bank for its records.

Manager/Agent.

…………………..Bank.

Date :……………………………

Place :……………………………

Returned with compliments to the Manager/Agent…………………Bank. The charge created under the declaration is duly included in the Record of Rights on the………..day of……………………………………19…………

Date :…………………………………………… Village Accountant or other designated revenue officer.

Forwarded with compliments to the Sub-Registrar, with a request to record the particulars of the charge……………………………created under the declaration in this office.

Manager/Agent

…………………..Bank.

Date :……………………………

Place :……………………………

Returned with compliments to the Manager/Agent ………………………………… Bank. The charge created under the declaration is duly recorded.

Date :……………………………

Sub--Registrar.