119Schedule – 19(A)
(Related to Sub-rule (1) of Rule 24a.)
The Land Reform Officer
Land Reform Office ……………………..
Subject :- Let the list (lagat) of Tenant to be deleted / removed.
We as a landowner and tenant of the following land has been submitting this
application making mutual consensus to remove / delete the list of the tenant by
maintaining (retaining) the whole land in the name of one person after dividing
the land as follows and receiving the amount of the land which fall in the part,
which has been equivalent to the price at the prevailing rate.
Detail of Land

1. Details of terms and conditions of partition of the land.
2. If the whole land has to be registered in one persons name, It’s detail.
3. The documents to be attached :-
(1) Copy of landowner registration certificate.
(2) Copy of Tenant certificate.
(3) Receipt of current fiscal years land revenue.

119 Inserted by Fifteenth Amendment.
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(4) Copies of citizenship certificates of Tenant and Landowner.
(5) Trace map of the concerned land.
(6) Others.
Applicants,-
Landowners;- Tenants;-
Signature :- Signature :-
Address :- Address :-
Father’s Name :- Father’s Name :-
Date :- Date :-