I/We,  Shri/Smt./Messrs. ___________________________________ intending member of the ______________________  Co-operative Housing Society Ltd. at _________ ___________________________________ proposing to hold flat No.   _____________ having ____________ sq.metres area, in the building of the society, constructed or to be constructed, hereby  declare that I/We do not hold any vacant land or land with a building thereon, anywhere in any urban agglomeration, mentioned in the Urban land (Ceiling and Regulation) Act, 1976, the area of which exceeds 500 sq.metres.  

    
Signature of the Transferee / Buyer
    

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