Lampiran 1
FORM A
Folio No ………………
APPLICATION FOR REFUND OF ADVANCE LAND RENT
( LAC No.1/2016 )
1. Name of applicant: ..…………………………………………………. WNKP No: ……………………………
2. Address : …………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………
3. Tel No / HP No: ……………………………………………………….…………………………………………..
4. Email address : ………………………….………………………………………………………………………...
5. Name of bank and address: ………………………………………………………………………………………
6. Bank Account No………………………………………………..(Attach copy of front page of Bank Booklet)
7. List of land titles with Advance rent : No.
Lot
Block/
Section
Land District
Amount
Remark
(*If space is insufficient, use separate sheet)
8. If any land is owned by more than one registered owner / proprietor, consent of other registered co- owners
/ proprietors that the refund is to be paid to any one of the owner is needed, where necessary ( To complete
Form B) (Consent of other registered co-owners )
9. Signature of applicant : ……………………………………….....
Name of Applicant
: ………………………………………….
Date
: ………………………………………….
OFFICIAL USE:
RECEIVED AND CHECKED BY : NAME OF REFUND OFFICER:………………….. SIGN :………………
DATE RECEIVED: ……………………………...
APPLICATION NO.: …………………………...
BATCH NO. ASSIGNED ………………………..
This form is available at any Lands and Surveys Revenue Counter and can be downloaded from http://www.landsurvey.sarawak.gov.my
Lampiran 1
FORM B
CONSENT OF OTHER REGISTERED CO-PROPRIETORS
We, the undersigned hereby consent to the refund of advance rent in respect of Lot …………….
…………………………………………… Block/Section ……………………………………….. Land District
to be paid to Encik/ Puan ………………………………………WNKP No. ……………………………………
herein after referred to as “Applicant For Refund”.
( 1)
……………………………………………WNKP…………………………….
SIGN:………………..
( 2)
……………………………………………WNKP…………………………….
SIGN:………………..
( 3)
……………………………………………WNKP…………………………….
SIGN:………………..
( 4)
……………………………………………WNKP…………………………….
SIGN:……………..,…
( 5)
……………………………………………WNKP…………………………….
SIGN:………………..
( 6)
……………………………………………WNKP…………………………….
SIGN:………………..
( 7)
……………………………………………WNKP…………………………….
SIGN:………………..
( 8)
……………………………………………WNKP…………………………….
SIGN:………………..
SIGNED IN THE PRESENCE OF :-
……………………………………
(Name of witness)
WNKP No…………………………….
This form is available at any Lands and Surveys Revenue Counter and can be downloaded from http://www.landsurvey.sarawak.gov.my
Lampiran 1
FORM C
DECLARATION ON NON-ACCEPTANCE OF LAND RENT REFUND
I ……………………………………………………,WNKP No. …………………………………………………….
have no objection for money deposited for land rent payment in respect of lot shown in the schedule below
to be credited into State Government Revenue Account.
No.
Lot
Block/
Section
Land District
Signature of applicant
: ……………………………………….....
Name of Applicant
: ………………………………………….
Date
: ………………………………………….
Amount
Remark
OFFICIAL USE:
RECEIVED AND CHECKED BY : NAME OF REFUND OFFICER:………………….. SIGN:……………...
DATE RECEIVED: …………………………….....
FILE REFERENCE : ………………………………………………………….
This form is available at any Lands and Surveys Revenue Counter and can be downloaded from http://www.landsurvey.sarawak.gov.my