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TENANT / PAYING GUEST INFORMATION REPORT AND DECLARATION OF THE LANDLORD

(Report of the particulars of a person put into occupation of let premises, made by the landlord to the officer in charge of the police station within whose jurisdiction the premises lie)

To
The Station House Officer
Police Station __________
__________
District __________

Place: __________
Date: __________

Sir / Madam,

WHY THIS REPORT IS BEING MADE

1. 2. This report is being submitted __________. I request that it be taken on record and that an acknowledgement be endorsed on the counterfoil at the foot of this report.

PART ONE - PARTICULARS OF THE LANDLORD

PART TWO - PARTICULARS OF THE PREMISES LET

PART THREE - PARTICULARS OF THE OCCUPANT

PART FOUR - PERSONS WHO WILL LIVE WITH THE OCCUPANT

Name, age, gender and relationship to the occupant of every other person who will ordinarily live at the premises, or the word None where the occupant will live alone:

PART FIVE - TERMS ON WHICH THE PREMISES ARE HELD

PART SIX - ANTECEDENTS DECLARED BY THE OCCUPANT

Particulars of the case or cases so declared, being the police station, the first information report number and year, the sections charged, the court and the present stage or the final order; or the words "None declared" where the occupant has declared that there is no such case:

PART SEVEN - FURTHER PARTICULARS, SO FAR AS THEY APPLY

Only the lines that apply to this letting are printed below. Where a line does not appear, the landlord states that there is nothing to report under it.

PART EIGHT - DOCUMENTS TO BE ENCLOSED WITH THIS REPORT

(Tick each box before you sign. This Part is a checklist of what must travel with the report. It is not a statement of particulars and the landlord's declaration below does not certify it.)

( ) Self-attested copy of the identity document of the occupant named in Part Three, both sides.
( ) Self-attested copy of the identity document of the landlord named in Part One, both sides.
( ) Two recent passport-size photographs of the occupant.
( ) One recent passport-size photograph and a self-attested identity copy for every adult named in Part Four.
( ) Copy of the written tenancy or paying-guest agreement, where one has been made and its date is given in Part Five.
( ) Proof of the landlord's title to or lawful possession of the premises, being the sale deed, the allotment letter, the conveyance deed, the lease deed, the latest jamabandi entry or the latest property tax receipt.
( ) Proof of the occupant's permanent address, being the address page of the identity document or a recent utility bill for that address.
( ) A sheet signed by the occupant giving the names and contact numbers of the occupant's father, mother, spouse, brothers and sisters.

DECLARATION OF THE LANDLORD

1. 3. I declare that the particulars stated in Parts One to Seven above are true to the best of my knowledge, information and belief, that I have concealed nothing material, and that I have myself seen the original of every identity document of which a copy is enclosed.

1. 4. I declare that I have not put any person into occupation of the premises described in the Schedule other than the person named in Part Three and the persons, if any, named in Part Four.

1. 5. I undertake to report to this police station, in this same form, the particulars of any further person who is put into occupation of the premises, any change in the persons living there, and the date on which the occupant named in Part Three vacates.

1. 6. I undertake to report immediately to this police station any conduct of the occupant, or of any person visiting the occupant, that gives me reason to suspect the commission of an offence.

1. 7. I understand that the making of this report does not amount to police clearance of the occupant, does not make the police a party to my agreement with the occupant, and gives me no additional right of eviction. I understand that the occupation of the premises is governed by my agreement with the occupant and by the rent law applicable to the premises, and that possession can be recovered only through the forum competent under that law.

1. 8. I understand that a report containing a particular I know to be false, or that I believe to be false, may attract prosecution independently of this report being filed.

1. 9. I make this report on my own behalf and, where the premises are jointly owned, with the authority of every co-owner.

DECLARATION AND CONSENT OF THE OCCUPANT

1. 10. I, the person named in Part Three above, have read, or have had read over and explained to me in a language I understand, the particulars recorded in Parts Three to Six of this report. Those particulars are correct.

1. 11. I have produced to the landlord the original of the identity document described in Part Three and I have given a self-attested copy of it for enclosure with this report.

1. 12. I consent to the particulars in this report, and the copies of the documents enclosed with it, being furnished to the police for the purpose of verification of my antecedents, and to their retention in police records for that purpose.

1. 13. I undertake to inform the landlord, and through the landlord this police station, of any change in the particulars stated in Parts Three to Six, and of the date on which I vacate the premises.

SCHEDULE
(The premises to which this report relates)

SIGNED at __________ on __________.

ACKNOWLEDGEMENT COUNTERFOIL
(To be filled and returned by the police; the landlord should keep this)

Diary or receipt number: ____________________

Name of the police station: __________

Designation of the receiving officer: ____________________

Signature and seal of the receiving officer: ____________________

Note for the landlord: keep this counterfoil, and keep the acknowledgement or application number generated by the online channel if the report was filed that way. It is the only proof that the report was made, and it is what answers a prosecution for not having made it.