(1) Any person or landlord, aggrieved by any decision or order of Local Authority may file an appeal to the District Task Force, within a period of 30 (thirty) days from the date of receipt of the decision of the Local Authority.
(2) Any person, aggrieved by any decision or order of the District Task Force, may file an appeal to the Commissioner of Division within a period of 60 (sixty) days, from the date of receipt of the decision or order of the District Task Force.
(3) The decision or order of the Commissioner of Division shall be final.
S. KHARLYNGDOH, Secretary to the Govt. of Meghalaya, Political Department.
PART-IIA] THE GAZETTE OF MEGHALAYA (EXTRAORDINARY) AUGUST 14, 2017 1054 Form I (see sub-rule (1) of Rule 4) TO WHOM IT MAY CONCERN No. Dated........ 20.....
This is to certify that Shri/ Smti__________________________________ S/o/D/o ________________ age _________ years by profession _________________________ was/is residing at ___________________________________ (address) in Village/Town/City within the jurisdiction of __________________________________ P.S. ____________ District _____________________________________State from ___________________________ to __________________/ till date.
This certificate is issued after I have satisfied myself with regard to the particulars of self-declaration submitted by Shri/Smti _____________________ vide Affidavit, dated_______ 20__made in Form ‘A’ along with particulars furnished in Form ‘B’ as provided under Section 9(1) (a) and Section 9 (2) of the Meghalaya Residents Safety and Security, Act, 2016(Meghalaya Act No. 6 of 2016).
Name and signature of Local Authority Address of Local Authority Phone Number (Office Seal)
PART-IIA] THE GAZETTE OF MEGHALAYA (EXTRAORDINARY) AUGUST 14, 2017 1055 Form II (see Rule 6) Database of Tenants residing in (Locality name & place/address) N am e/ g en de r/ A ge o f t en an t N at io na li ty o f te na nt N am e of F at he r / M ot he r /S po us e of te na nt N am e of la nd lo rd , a dd re ss & T el / M ob il e N o.
T el / M ob ile N o.
& E -m ai l of T en an t O cc up at io n of te na nt P er m an en t A dd re ss o f te na nt D oc um en ts p ro du ce d in su pp or t o f id en ti ty o f te na nt D at e of o cc up at io n as pr es en t t en an t P re vi ou s ad dr es s of te na nt N am e an d ag e of p er so ns re si di ng w it h te na nt & th ei r re la ti on sh ip w ith te na nt R em ar ks 1 2 3 4 5 6 7 8 9 10 11 12
PART-IIA] THE GAZETTE OF MEGHALAYA (EXTRAORDINARY) AUGUST 14, 2017 1056 Form – III A (see sub-rule (3) of Rule 7) DECISION OF THE LOCAL AUTHORITY Whereas, in pursuance of the provision under Section 7 of the Meghalaya Residents Safety and Security Act, 2016, the Local Authority after careful examination of the documents furnished by Shri/Smti.______________- _______(landlord) of ____________________(address) and Shri/Smti__________________________________ (tenant/intending tenant) of _____________________________(address), for the purpose of renting a house or rental unit hereby decided to grant clearance.
Now, therefore, accordingly, the clearance is granted by the Local Authority.
Place. . . . . . . . . . . . . . . ..
Date . . . . . . . . . . . . . . . .
Chairman Name & address with seal of Local Authority . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . .
PART-IIA] THE GAZETTE OF MEGHALAYA (EXTRAORDINARY) AUGUST 14, 2017 1057 Form – III B (see sub-rule (3) of Rule 7) DECISION OF THE LOCAL AUTHORITY Whereas, in pursuance of the provision under Section 7 of the Meghalaya Residents Safety and Security Act, 2016, the Local Authority after careful examination of the documents furnished by Shri/Smti.______________- _______(landlord) of ____________________(address) and Shri/Smti__________________________________ (tenant/intending tenant) of _____________________________(address), for the purpose of renting a house or rental unit hereby decided not to grant clearance.
Now, therefore, accordingly, the clearance is not granted by the Local Authority for the reasons stated below.
Reasons for rejection_______________________________________________________ ___________________________________________________________________________ Place. . . . . . . . . . . . . . . ..
Date . . . . . . . . . . . . . . . .
Chairman Name & address with seal of Local Authority . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . .
PART-IIA] THE GAZETTE OF MEGHALAYA (EXTRAORDINARY) AUGUST 14, 2017 1058 FORM IV [see sub-rules (2) & (6) of Rule 8] APPLICATION FORM TO BE FILLED IN BY PERSON ENTERING THE STATE OF MEGHALAYA Form No._________________
1. Name(as in identity document):
2. Permanent address:_________________________________________________________ State_____________________ District ________________ Taluk__________________ Police Station______________ Post Office______________ Mobile No.___________
3. Date of Birth:
4.Gender:
*5.Details of person accompanying (in case of minor child/children only):
Names Age Relationship Gender 1 ............. ......... ................. ...........
2 ............. ......... ................. ...........
6. (a) Identity Card Type..................... 6.(b) Identity Card No .......................
7. (a) Date of arrival 7. (b) Likely date of departure
8. (a) Travel by Bus/Car/Two-wheeler/Train/Air (tick whichever is applicable) any other.............................. (please specify)
8.(b) (Give vehicle/Train/Flight Nos) .............................................................................
9.Address during stay in Meghalaya/address of referred person in Meghalaya Mobile /Contact No Reference person in Meghalaya Name ____________________ Address _________________________ Police Station______________ Post Office______________ Mobile No.______________
10. Telephone/Mobile No. 11. Purpose of visit:
Date ................ Signature of person *Strike off if not necessary ...........................................................cut here ............................................................
M F O (Tick whichever is applicable) Tourist/Employment/Service/Education If any other please specify: ______________
PART-IIA] THE GAZETTE OF MEGHALAYA (EXTRAORDINARY) AUGUST 14, 2017 1059 ACKNOWLEDGEMENT RECEIPT Received Form No.____dated_________ from Shri/Smti ______________________ entering State of Meghalaya on ___________ (date) at _____________________ (place).
(This acknowledgement receipt should be returned to the concerned Facilitation Centre at the time of exiting out of the State) Signature& seal of In-charge Facilitation Centre Exited the State on ____________ (date) at _______________________(place) Signature & seal of In-charge Facilitation Centre
PART-IIA] THE GAZETTE OF MEGHALAYA (EXTRAORDINARY) AUGUST 14, 2017 1060 FORM “A” [See section 9 (1) (a)] Affidavit [To be typed on a Rupees Ten Non-Judicial Stamp Paper] I………………………….(Name of deponent), S/o / D/o,………………., age about……years, by profession ………………… and permanent resident of………………………… do hereby solemnly affirm and declare as follows:-
1. That I am a bonafide resident of India and presently reside at……………………….
2. That I was a previous resident of …………… village/ town/ city ………. within the jurisdiction of the ……………. Police Station, ……………. District, …………. State, from……to….. (period).
3. That this Self Declaration is for declaring my earlier residence for the purpose of Section 9 (1) (a) of the Meghalaya Residents Safety and Security Act, 2016 and submitting the same before the concerned authority with supporting documents referred to in section 9.
4. That the statements in this Declaration made in paragraphs 1, 2 and 3 above are true and correct to the best of my knowledge, belief and information and nothing material has been concealed therein.
5. That if any information given by me in this declaration or any document submitted in support of any residential address shall be found untrue or incorrect or false I would be liable for penalties under Sections 199 and 200 of the Indian Penal Code,
1860.
References - Name and address/Phone/Mobile.
1.
2.
Signature and Address of Tenant/ Phone/Mobile.
PART-IIA] THE GAZETTE OF MEGHALAYA (EXTRAORDINARY) AUGUST 14, 2017 1061 Form-B [See Section 9(2)] Details of information of resident for verification by Police and Local Authority.
Particulars of Landlord where the tenant resides.
1. Name of the Landlord: ______________________________________________________
2. Occupation: ________________________________________________________________
3. Details of permanent address: _______________________________________________
4. Telephone/ mobile number: _________________________________________________
5. Present address: ____________________________________________________________
6. Details of domestic help or other workers staying along with the landlord:
Name Age Permanent Residential Address Signature/Thumb Impression ________________________________________________________________________________ ________________________________________________________________________________ (*NB: Separate sheet be used to affix photograph of domestic help or other workers along with name and signature or thumb impression below the photograph) Particulars of Tenant
1. Name: ___________________________________________________________
2. Father’s name/ mother’s name/spouse’s name:___________________
3. (a) Nationality: ____________________ (b) Age : ______________________
4. Address:__________________________________________________________
5. Phone Number:___________________________
6. Mobile number: __________________________
7. Email address:____________________________
8. Occupation: ______________________________________________________
9. Documents produced in support of address and identification:
(a) If student, certificate and identity card from the educational institution: _________
(b) If Government servant, employment certificate, transfer order or appointment order or office identity card: _____________________
(c) For doctors / lawyers/ engineers/ architects/ professional drivers/ self employed and other professionals - registration certificate/ number:______________________
(d) For migrant workers or those engaged in business/ trade: trading license from respective District Council or labour registration certificate/ license under relevant law: _________________________________________________________________
PART-IIA] THE GAZETTE OF MEGHALAYA (EXTRAORDINARY) AUGUST 14, 2017 1062
(e) For others - Permanent Account Number (PAN) card/ electricity bill/ ration Card/Adhaar card: ___________________
10. Details of family member residing with the tenant and includes sub-tenants and joint tenants:
Name Age Relationship Occupation Signature/Thumb Impression __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
11. Details of domestic help or other workers staying along with the tenant:
Name Age Permanent Residential Address Signature/Thumb Impression __________________________________________________________________________________ ___________________________________________________________________________________ (*NB: Separate sheet be used to affix photograph of family members and domestic help along with name and signature or thumb impression below the photograph)
12. Present Address:
& Telephone and Mobile Number:
13. Previous address:
& Telephone and Mobile Number:
14. Date of leaving the previous address:
15. Permanent address:
& Telephone and Mobile Number (to be supported by documentary proof) *Strike out whichever not necessary Name and Signature of tenant with date / address and Phone/ Mobile.
Name and Signature of Landlord with date/address and Phone/Mobile.
PART-IIA] THE GAZETTE OF MEGHALAYA (EXTRAORDINARY) AUGUST 14, 2017 1063 A c k n o w l e d g e m e n t Received from Shri/ Smti. ___________________________ S/o / D/o _______________________ R/o ________________________________ Phone / Mobile Number ___________________________ intimation of letting out of ____________________________ to Shri/ Smti. ___________________ _________________________________.
Date __________ Diary No. ______________ Signature of recipient ____________________ Name & Designation ____________________ Police Station ___________________ Office Seal A c k n o w l e d g e m e n t Received from Shri/ Smti. _________________________ S/o / D/o _________________________ R/o ________________________________ Phone / Mobile Number __________________________ intimation of letting out of ____________________________ to Shri/ Smti. ___________________ _________________________________.
Date __________ Diary No. ______________ Signature of recipient ____________________ Name & Designation ________________________ Police Station ___________________ Office Seal SHILLONG: Printed and Published by the Director, Printing and Stationery, Meghalaya, Shillong.
(Extraordinary Gazette of Meghalaya) No. 295 - 730 + 200 — 14 – 8 - 2017.
website:- http://megpns.gov.in/gazette/gazette.asp