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(On Rs. 100/- Bond)AFFIDAVITForm 4Name: (Owner's Name)___________________________________Address (Owner's Address) ____________________________________Details about the land on which development is proposedKhasra No. _____________________ Plot No. _____________________Construction Site: ___________________________________________I/We, the deponent as under, do hereby solemnly affirm and declare as under :1. That I/We am/are owner/holder of ________measuring_________ sq. mts. of area.2. That I/We have proposed to develop and construct building on the aforesaid plot ofland. The construction work shall be done by me/us through my/our contractor tobe appointed in due course under my/our personal responsibilities.3. That I/We have submitted the plans for the construction of the building over thesaid plot of land.4. I/We hereby appoint Mr. _________________________as anArchitect/Engineer/Licentiate Supervisor who's License No. is ________________.He/She shall be responsible for making the building plans in accordance with theprovisions of Master Plan, Bye Laws and other applicable rules and regulations.5. I/We hereby given an authority to an Architect/Engineer/Licentiatic Supervisor forsubmitting the building plan for approval and collecting the approval plans andaccept the terms and conditions of approval letter on behalf of me/us.6. I, ___________________________________ as an Architect/ Engineer/ LicentiateSupervisor, bearing License No. ______________accept the responsibilites as anArchitect/Engineer/licentiatc Supervisor fo the above-proposed development. Ishall be responsible for making the building plans in accoradance with theprovisions of Master Plan, Bye Laws and other applicable rules and regulations.7. I/We hereby appoint Mr. ________________________________ as StructuralDesigner whose license No. is _____________. He/She shall work as StructuralDesigner for the above-proposed development and perform his/her duties. He/Sheshall be responsible for making the structural design and providing structuraldetails.I Verified that the contents of paras 1 to 7 of this affidavit are true and correct tomy personal knowledge and belief and nothing material has been concealed.Sworn and affirmed at Dehradun on __________day of ______200____Organizer/Builder/Owner/Developer Architect/Engineer/Licentiate SupervisorSignatureSignatureNameNameS/oS/oAddressAddressStructural DesignerSignatureNameS/oAddress