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[Entire Act]
State of Punjab - Section
Section 12 in The Punjab Security of Land Tenures Rules, 1953
12. [ Conditions for Co-operative Farming Societies. [Added by Punjab Government Notification No. 8918-R (Ch.) 2531 595, dated the 29th April, 1954.]
- For the purposes of clause (ii) of sub-section (4) of section 1 of the Act, a co-operative farming society shall fulfil the conditions of a registered society governed by bye-laws for a co-operative Better Farming Society, Limited, and the rules made under the Co-operative Societies Act, 1912.] [Added by Punjab Government Notification No. 4341-ARI-(II)- 58/1568, dated 14th July, 1959.].[Annexure 'A'] [Substituted by Punjab Governemnt Notification No. 460-ARI(II)-59/1665, dated the 22nd April, 1959.]Valuation Statement for Hissar District(Figures represent value in annas per acre)| Tehsil | Class of Land | |||||||
| Irrigated (Nehri) | Irrigated Chahi | Unirrigated | Sailab | |||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| Hisar | All tehsilNon-PerennialAlltehsil | 1510 | All tehsil | 10 | Nehri HarianaBarani HarianaBagar | 543 | Nehri HarianaBarani HarianaBagar | 543 |
| Bhiwani (including Loharu (State) | Eastern HarianaRest of the tehsil | 1510 | All tehsil | 10 | Eastern HarianaWestern HarianaRest of thetehsil | 653 | . . | . . |
| Sirsa | PerennialAlltehsilNon-PerennialAlltehsil | 1510 | All tehsil | 10 | BagarRest | 45 | . . | . . |
| Hansi | PerennialAlltehsilNon-PerennialAlltehsil | 1610 | All tehsil | 10 | All tehsil | 5 | . . | . . |
| Fatehabad | All tehsil | 15 | All tehsil | 10 | BagarNehri | Barani Rangoi and NaliJungle | 456 |
| Tehsil | Class of Land | |||||||||
| Nehri | Barani | Bhud | Chahi | Sailab | ||||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| Rohtak | All tehsil | 16 | Nehri I, II and IIIRest | 98 | Nehri I, II and IIIRest | 64 | All tehsil | 16 | . . | . . |
| Gohana | All tehsil | 17 | MohmEasternWestern and Southern | 8109 | MohmEastern, Western and Southern | 46 | All tehsil | 17 | . . | . . |
| Sonepat | Bagar | 16 | All tehsil | 10 | All tehsil | 7 | BagarKhadir | 1716 | All tehsil | . . |
| Jhajjar | Nehri seasonalAll tehsil | 10 | All tehsil | 8 | All tehsil | 4 | All tehsil | 16 | . . | . . |
| Tahsil | Class of Land | |||||
| Chahi | Abi | Dehri | ||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Nuh | All tahsil exceptTaoruTaoru | 1012 | All tahsil | 9 | All tahsil | 8 |
| Rewari (including Pataudi State) | Chahat KhariChahat MithaPaharSahibi | 12141113 | .. | .. | All tahsil | 8 |
| Ferozepur-Jhirka | Bangar Budhor and Dahar Chiknot | 10129 | All tahsil | 9 | All tahsil except DaharDahar | 89 |
| Palwal | BangarKhadir | 139 | .. | .. | All tahsil | 8 |
| Ballabgarh | KhadirBangarDahar | 91312 | All tahsil | 8 | All tahsil | 8 |
| Gurgaon | Sohna and SahibiBhudGurgaon and Bahore | 121314 | All tahsil | 8 | SohnaGurgaonBahora | 787 |
| Class of Land | |||||||
| Ala Barani | Bhud | Nehri | Sailab | ||||
| Area or assessment circle | Valuation | Area or asssessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation |
| 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 |
| All tahsil | 7 | All tahsil | 4 | PernnialAll tahsilNon-PerennialAll tahsil | 1610 | .. | .. |
| Chahat Khari and MithaRest | 65½ | All tahsil | 4 | .. | .. | .. | .. |
| All tahsil except DaharDahar | 79 | All tahsil exceptDaharDahar | 45 | Bangar | 16 | .. | .. |
| BangarKhadir | 86 | All tahsil | 4 | BangarKhadir | 1612 | All tahsil | 8 |
| All tahsil exceptBangarBangar | 68 | All tahsil | 4 | PerennialAll tahsil | 16 | Khadir | 8 |
| SahibiSohna, Gurgaon andBhudBahara(Chiknot)Bahora other | 5676 | All tahsil | 4 | .. | .. | .. | .. |
| Tahsil | Class of Land | |||||||||
| Chahi and Abi | Chahi | Nehri | Unirrigated | Nehri/Non-Perennial or other Nehri Inundation | ||||||
| Area or assesment circle | Valuation | Area or assesment circle | Valuation | Area or assesment circle | Valuation | Area or assessment circle | Valuation | Area or assesment circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| Karnal | All tahsil except Bangar Indri and BagarKarnal..Bangar Indri & Bangar Karnal | 1516 | .. | .. | All tahsil | 16 | All tahsil | 9 | All tahsil | 12 |
| Panipat | .. | .. | All tahsil | 6 | Khadir CircleB angar | 1617 | All tahsil | 10 | All tahsil | 12 |
| Thanesar | All tahsilexceptSouthernChachraSouthernChaehra | 1615 | .. | .. | .. | .. | Bet Mark anda and Khadir circles Rest of theTehsil | 109 | 9All tahsil | 12 |
| Kaithal | All tahsil .. | 10 | .. | .. | All tahsil | 16 | Nardak and BangarBangarPahowa and Naili,Indarwar and Powadh | 8½89 | All tahsil | 12 |
| Tahsil | Class of Land | |||||
| Chahi | Chahi and Abi | Chahi Nehri and Abi | ||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area orassesment circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Ambala | .. | .. | All tahsil | 15 | .. | .. |
| Jagadhri | .. | .. | .. | .. | All tahsil | 15 |
| Rupar | All tahsil exceptGhar Bet circleGhar Betcircle | 1614 | .. | .. | .. | .. |
| Naraingarh | All tahsil | 15 | .. | .. | .. | .. |
| Kharar | .. | .. | All tahsil exceptSeoti and II circlesSeoti Iand II circles | 1516 | .. | .. |
| Sailab | Abi | Barani and BaghBarani | |||
| Area orassessment circle | Valuation | Area orassessment circle | Valuation | Area orassessment Circle | Valuation |
| 8 | 9 | 10 | 11 | 12 | 13 |
| All tahsil .. | 9 | .. | .. | All tahsil | 10 |
| All tahsil .. | 9 | .. | .. | Kandi and Nothern Jamna Khadar circlesBangerCircleSouthern Jamna Khadarand Som Khadar circle | 810811 |
| All tahsil .. | 9 | .. | .. | Bet and Dhaya circle..Ghar and Ghar Bet circle.. | 128 |
| All tahsil .. | 9 | SeotiGhar .. | 1614 | Seoti circle ..Ghar circle .. | 97½ |
| All tahsil .. | 9 | All tahsil .. | 14 | Seoti I circle ..Seoti II and Charsa circle ..Dakar and Nili circles ..Ghar .. | 121198 |
| Tahsil | Class of Land | |||||||
| Khul II | Lehri I | Lehri II | Kiar | |||||
| Area orassessment circle | Valuation | Area orassessment circle | Valuation | Area orassessment circle | Valuation | Area orassessment circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| Simla | All tahsil | 12 | All tahsil | 12 | All tahsil | 8 | .. | .. |
| Kot Khai | .. | .. | .. | .. | .. | .. | All tahsil | 12 |
| Kiar I | Kiar II | Bakhal | Karoli I | Karoli II | |||||
| Area or assessment circle | Valuation | Area orassessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation |
| 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 |
| .. | .. | .. | .. | .. | .. | .. | .. | .. | .. |
| All tahsil | 16 | All tahsil | 13 | Kot KhaiKot Guru | 86 | Kot KhaiKot Guru | 64½ | Kot KhaiKot Guru | 32 |
| Tahsil | Class of Land | |||||||
| Irrigated | ||||||||
| Area or assessment Circle | Valuation | Area or assessment Circle | Valuation | Area or assessment Circle | Valuation | Area or assessment Circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| Kangra | Palam | 11 | Rehlu | 10½ | Kangra | 11 | Ramgarh | 10 |
| Hamirpur | Mahl Morian | 6½ | .. | .. | .. | .. | .. | .. |
| Dehra.. | Dada SibaGangotMangarh and Nagrota..Rest oftahsil.. | 8½910 | .. | .. | ChanaurJaswanDhametn | 689½ | .. | .. |
| Palampur | 10½ | .. | .. | .. | .. | .. | .. | |
| Nurpur | Nurpur..Chattar and Jowali..Andraura.. | 8½9½12½ | .. | .. | LodhwanKhairanSurajpur | 911½7½ | .. | .. |
| Kulu | Rapa I..Rapa II..Rapa III.. | 121110 | .. | .. | .. | .. | .. |
| Unirrigated | |||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation |
| 10 | 11 | 12 | 13 | 14 | 15 |
| Palam and Rehlu | 5 | Bargaon, Kangra and Ramgarh | 6 | .. | .. |
| DofasliKutlehar ..Nadan ..NandauntaMahlMorian ..Tirah ..Rajgiri .. | 5½655½4½4 | EkfasliKutlehar ..Nadan ..Nandaunta ..MahlMorianTirah ..Rajgiri .. | 3½43½3½3½3 | Khareta | .. |
| Chanaur Jaswan and NagrotaGangotBalihar,Changar | 5½6½ | HaripurRest of tahsil | 76 | ||
| Palam and ChangarRajgiri ..Gadheran .. | 66½6½ | Gadheran | 3 | Gadheran | 1½ |
| All tahsil exceptSurajpur ..Surajpur .. | 56 | All tahsil exceptSurajpur ..Surajpur .. | 56 | .. | .. |
| Bathal I ..Bathal III .. | 104½ | Bathal II..Bathal IV | 6½3 | .. | .. |
| Tehsil | Class of Land | |||||||||||
| Chahi | Abi | Barani I | Barani II | Barani III | Nehri Shahnahr | |||||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 |
| Hoshiarpur | SirwalKandiRakkar | 181216½ | SirwalKandiRakkar | 161215 | SirwalKandiRakkar | SirwalKandiRakkar | 11610 | SirwalKandiRakkar | 846 | .. | .. | |
| Dasuya | Maira and Bet Sirwal Rakkar Kandi | 1616½13 | SirwalMaira and Bet Rakkar Kandi | 16½161312 | MairaKandiSirwal Bet Rakkar | 1014118 | SirwalMairaBetRakkarKandi | 108957 | Sirwal &MairaBet Rakkar Kandi | 7635 | All tahsil | 15 |
| Una | All tahsil except ChangarChangar | 1210 | .. | .. | .. | .. | .. | .. | .. | .. | .. | .. |
| Garhshankar | .. | .. | .. | .. | Bet and RakkarBit Sirwal Kandi | 1110139 | Bet and RakkarBit Sirwal Kandi | 98107 | Bet andBit Kandi Sirwal Rakkar | 5486 | .. | .. |
| Chamb | Chahi Abi | Nehri Abi | Dofasli Garden | Ekfasli I | Ekfasli II | ||||||
| Area or assesment circle | Valuation | Area or assesment circle | Valuation | Area or assesment circle | Valuation | Area or assesment circle | Valuation | Area or assesment circle | Valuation | Area or assesment circle | Valuation |
| 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 |
| .. | .. | .. | .. | .. | .. | .. | .. | .. | .. | .. | .. |
| All tahsil | 10 | .. | .. | .. | .. | .. | .. | .. | .. | .. | .. |
| .. | .. | .. | .. | All tahsil exceptDunDun | 910 | Changr &Pahar Bet Dun &Bit Ghar | 697 | Changer & PaharBetGharDunBit | 464½75½ | All tahsile exceptBet & DunBet & Dun | 35 |
| .. | .. | .. | Bet Sirwal and Rakkar Kandi | 141613 | .. | .. | .. | .. | .. | .. | .. |
| Tehsil | Class of Land | |||||||||
| Chahi Abi | Barani I | Barani II | Barani III | Sailab | ||||||
| Area or assement circle | Valuation | Area or assement circle | Valuation | Area or assement circle | Valuation | Area or assement circle | Valuation | Area or assement circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| Jullundur | All tahsil exceptDona LahndaDona Lahnda | 1615 | SirwalDona ChardaDona Lahnda | 121110 | SirwalDona ChardaDona Lahnda | 11108 | SirwalDona ChardaDona Lahnda | 876 | ||
| Nawanshahr | All tahsil exceptDhakDhak | 1617 | DhakRetliBetDhaya Bet UpperDhaya Bet Lower | 121191212 | DhakRetliBetDhaya Bet UpperDhaya Bet Lower | 109999 | DhakRetliBetDhaya Bet UpperDhaya Bet Lower | 88787 | DhakDhaya BetBet | 12109 |
| Phillaur | All tahsil | 16 | All tahsil | 11 | All tahsil | 11 | All tahsil | 7½ | ||
| Nakodar | ManjkiDonaBet | 161514 | ManjkiDonaBet | 12109 | ManjkiDonaBet | 988 | ManjkiDonaBet | 778 | ManjkiDonaBet | 161514 |
| Tehsil | Class of Land | |||||||||
| Bet Chahi | Bet Barani | Chahi Niai | Chahi Khalis | Nehri Khalis | ||||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| Ludhiana | All tahsil exceptLower DhayaLower Dhaya | 1316 | All tahsil exceptEasternBetEastern Bet | 67 | All tahsil exceptJangalJangal | 1716 | All tahsil | 16 | All tahsil exceptJangal perennialNon-perennialJangal ParennialNon-perennial | 16121511 |
| Samrala | All tahsil | 13 | All tahsil | 7 | Lower DhayaUpper Dhaya | 1617 | All tahsil | 15 | 810 | |
| Jagraon* | All tahsil | 14 | Bet LowerDhaya | 76 | All tahsil | 17 | All tahsil | 16 | Perenni All tahsilNon-perennial All tahsil | 1612 |
| Dakar Rousi | Bhud | Nehri Niai | Chahi Nehri | ||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation |
| 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 |
| Lower Dhaya andJangal Upper Dhayaand Powadh | 810 | All tahsil exceptLower DhayaLower Dhaya | 76 | PerennialAll tahsil exceptJangalJangalNon-perennialAll tahsil exceptJangalJangal | 16151511 | ||
| Lower DhayaUpper Dhaya | 810 | Lower DhayaUpper Dhaya | 67 | ||||
| Bet Lower DhayaUpperDhaya | 7910 | All tahsil exceptBetBet | 86 | PerennialAll tahsilNon-perennialAll tahsil | 1712 | All tahsil | 17 |
| Tehsil | Class of Land | |||||||||
| Chahi | Chahi Nehri Zila | Nehri Zila | Nehri Illahiwah | Nehri Sirhind | ||||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| Ferozepur | All tahsil | 15 | All tahsil | 15 | All tahsil | 12 | .. | .. | Rohi | 17 |
| Fazilka | All tahsil | 12 | All tahsil | 12 | All tahsil | 12 | .. | .. | RohiUttar | 1616 |
| Mamdot Jagir | All tahsil | 15 | All tahsil | 15 | All tahsil | 12 | .. | .. | .. | 12 |
| Zira | All tahsil | 15 | All tahsil | 15 | All tahsil | 12 | .. | .. | .. | .. |
| Moga | All tahsil | 16 | All tahsil | 15 | All tahsil | 12 | All tahsil | 12 | All tahsil | 17 |
| Muktsar | All tahsil | 14 | All tahsil | 14 | All tahsil | 12 | .. | .. | All tahsil | 16 |
| Nehri Zila Jhalari | Chahi Nehri Sirhind | Sailab | Barani | ||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation |
| 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 |
| .. | .. | .. | All tahsil | 18 | BetRohi | 89 | |
| All tahsil | 12 | .. | .. | All tahsil | 7 | All tahsil exceptRohiRohi | 67.. |
| 12 | .. | .. | All tahsil | 7 | All tahsil exceptRohiRohi | 7.. | |
| .. | .. | .. | All tahsil | 8 | BetRohi | 810 | |
| All tahsil | 12 | All tahsil | 16½ | .. | .. | All tahsil exceptMaharajaMaharaja | 108 |
| .. | .. | .. | All tahsil | 7 | All tahsil exceptUttar Kot KapuraUttar Kot Kapur | 7 |
| Tehsil | Class of Land | |||||||||
| Chahi | Nehri | Sailab | Barani | Abi | ||||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| Amritsar | All tahsil except Bet Banger and Mirankot circlesBet Banger circle Mirankot circle | 1716½16 | Perennial All tahsilNon-perennial All tahsil | 1714 | All tahsil | 8 | Bet Banger Circle Jandiala CircleNehri circleMirankot circle | 9½91110 | ||
| Ajnala | Sailab circleHithar circleUttar circleNehri circle | 14½1516½17 | Perennial All tahsilNon-perennial All tahsil | 1714 | All tahsil exceptSailab CircleSailab Circle | 89 | Sailab circleHithar circleUttar circleNehri circle | 788½9 | Sailab circleHithar circleUttar circleNehri circle | 788½9 |
| Tarn Tarn | All tahsil exceptBet Banger circleBet Bangercircle | 15½15 | Perennial All tahsilNon-perennial All tahsil | 1714 | All tahsil | 9 | All tahsil except Upper Manjha circle Upper Manjhacircle | 910 |
| Tehsil | Class of Land | |||||||
| Chahi | Chahi and Abi | Chahi and Chahi Nehri | Chahi and Nehri Zamindari | |||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| Gurdaspur | Maira KirnBet Ravi | 1617 | All tahsil Nehri,Banger and Dhaya Bet BeasChahi NehriMairaKirn and Bet Ravi | 1616 | ||||
| Batala | All tahsil | 17 | All tahsil | 17 | Chahi NehriAlltahsil | 17 | ||
| Pathankot | All tahsil | 12 |
| Chahi, Nehri Zamindari | Nehri Zamindari Abi | Nehri | |||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation |
| 10 | 11 | 12 | 13 | 14 | 15 |
| Nehri ZamindariMaira Kirn | 14 | All tahsil Nehri PerenniaNehri Non-perennial | 1714 | ||
| Nehri ZamindariAll tahsil | 14 | Nehri PerenniaNon-perennialAll tahsil | 1714 | ||
| All tahsil | 12 | All tahsil | 12 | All tahsil | 12 |
| Sailab | Chammb Sailab | River Sailab | Sailab and Barani I | Barani Bet Ravi | |||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation |
| 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 |
| All tahsil exceptBet RaviBet Ravi | 1214 | All tahsil | 12 | All tahsil | 12 | All tahsil | 14 | ||
| All tahsil | 12 | All tahsil | 12 | All tahsil exceptMajra KirnMaira Kirn | 1312 | All tahsil | 11 | ||
| All tahsil exceptBet RaviBet Ravi | 910 | Barani Andher Bet Ravi, Patnanti Shah Nehri | 9 |
| Barani I | Barani I | Barani I | Abi | ||||
| Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation | Area or assessment circle | Valuation |
| 26 | 27 | 28 | 29 | 30 | 31 | 32 | 33 |
| All tahsil | 12 | DhayaBet BeasRest of the tehsil | 910 | All tahsil | 14 | ||
| All tahsil | 12 | All tahsil | 10 | ||||
| KandiPahari | 109 | KandiPahari | 86 | All tahsil | 4 |
| ABPASHI | DANG | ||
| Area or Assessment circle | Valuation | Area or Assessment circle | Valuation |
| Lahaul | 12 | Lahaul | 3 |
| Spiti | 10 | | |
| Serial No. | Name with description and address of landowners | District and Tehsil wherein land is situate | Name of estate in which land held is situatewith patti or taraf | Details of Area Selected for Reservation in thewhole of the State of Punjab in Respect of which the LandownerReceives Rent Directly from the Tenants in Actual Cultivation ofthe land | |||||
| Land held in Proprietary right | Land held as mortgagee with possession | Land held as allottee | |||||||
| Field Nos. (a) | Area in ordinary acres (d) | Field Nos. (c) | Area in ordinary acres (d) | Field Nos. (c) | Area in ordinary acres (f) | ||||
| 1 | 2 | 3 | 4 | ||||||
| K.M. | K.M. | K.M. |
| Land held as lessee | Land held as landowner in any other capacitynot herein before specified | Total of items (b), (d), (f), (h) and (k) | Total area in column 5(1) converted intostandard acres | Remarks | |||
| Field Nos. (g) | Area in ordinary acres (h) | Nature of interest in land (1) | Field Nos. (I) | Area in ordinary acres (k) | Ordinary acres (I) | ||
| 5 | 6 | 7 | |||||
| K.M. | K.M. | K.M. | K.M. |
| Dated____________________19 | Signature_________________________ |
| Dated____________________19 | Signature_________________________ |