[See Rule 312(b)]

To, The Registrar/Deputy Registrar, Co-operative Societies, U.A. ................................................. Sir, We, the undersigned members of the Gaon Samaj ........................................................ Post-office ------------------ Pargana --------------------- Tahsil ------------------------------------ District ---------------------- , who have applied for the registration of ---------------------------------------- Co-operative Farming Society (District --------------) and hold between ourselves Bhumidhari and Sirdari rights in -------------------- acres of and in the circle ----------- desire to pool such land for the purposes of forming of a Co-operative Farming Society, under Clause (a) of Sub-section (1) of Section 77 of the Act, and do hereby agree to abide by all the relevant provisions of Act, Rules and the Bye-laws of the society. Sl. No. of Applicants Name of tenure-holders (applicants with parentage, residence and age) Nature of Tenure Khasra numbers of fields in the holding with area in acres or standard bighas show as denominator Total area of the holding Total land revenue of the holding Remarks 1 2 3 4 5 6 7 Signature of members Your’s faithfully 1………………. 3…………… 5…......... 7………. 9…………… 2………. 4……….. 6………………. 8………… 10……………. Enclosure: A copy of the certified extracts from the record-of-rights of the most recent year.