Date:....../....../............
MORTGAGE DECLARATION FORM (Land & Property Transaction)
1. Name of Owner: ..................................................................................................
2. Thram No.: ...................................................
3. Plot No.: ...................................................
4. Flat No.: .....................................................
5. Registered Area: ...............................................
6. Permanent Address: .............................................................................................
7. Contact No.: ...................................................................................
The above mentioned land and/ or partial property (Flats, Land, Secondary Charges etc...) are not mortgaged
to any of the following financial institutions.
Name of Banks YES NO
1. Bank of Bhutan Ltd: ☐ ☐
2. Bhutan National Bank Ltd: ☐ ☐
3. Royal Insurance Corporation of Bhutan Ltd: ☐ ☐
4. National Pension & Provident Fund: ☐ ☐
5. Tashi Bank Ltd: ☐ ☐
6. Druk PNBL Ltd: ☐ ☐
7. Bhutan Insurance Ltd: ☐ ☐
8. Bhutan Development Bank Ltd: ☐ ☐
If "yes" then should produce Clearance (Liquidation Certificate) or No objection Certificate from the concerned
Bank/ Financial Institution.
UNDERTAKING
I/ we hereby declare/ certify that the above mentioned/ given information is true and complete to the best of my/
our knowledge. In the event of detection of false, misleading or incorrect information pertaining to the above
mentioned land & property, I/ we shall take full responsible & accountable of the matter and shall be liable for
any penalties/ legal actions as per the law of Kingdom of Bhutan.
Witness : (Signature & Legal
Owner : (Signature & Attach Legal Stamp)
Stamp)
Name:
Name:
CID. No.:
CID. No.:
Present Address:
Present Address: