[ Under bye - law No. 19 (vii) and 40 (d) (ix)]

I/We, …………………………………………………………….. intending member of the ………………………………………… Co-operative Society Ltd., situated at ………………………………………………………...……………………………….. having …………. sq. feet area in the building of the society and intending to transfer it to ……………………………... intending member of the society, 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 / Prospective Member

Place :
Date  :