National Land Code
Form 19в
[Section 323]
APPLICATION FOR ENTRY OF A PRIVATE CAVEAT
To the *Registrar/Land Administrator.......................................................................................................
I,.................................................................................................................................................................
of.................................................................................................................................................................
hereby apply for the entry of a caveat upon the title to the land desribed in the schedule below; to be
expressed to bind—
*the land itself/the particular interest described in the said schedule.
2. The grounds of my claim to the *land/interest are—
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3. As required by section 323 of the National Land Code, I now submit—
(a) the prescribed fee of RM...........................................;
(b) a statutory declaration of *myself/my advocate and solicitor verifying the claim set out in
paragraph 2 above; and
(c) if relating to a part of the land, a description or a plan of the land affected, or if relating to an
undivided share in the land or part thereof, a description thereof.
**4. The last known address of the proprietor in my knowledge is:
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*5. I hereby agree to accept service by facsimile and the number is .........................................................
Dated this....................day of.......................,20....................
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Signature (or other form of execution)
by or on behalf of applicant
I,..................................................................................................................................................................
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hereby testify that the above *signature/thumb print was *written/affixed in my presence this
................... day of .........................., 20........................, and is the true *signature/thumb print of—
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who has acknowledged to me
(i) that he is of full age,
(ii) that he is a citizen of Malaysia,
(iii) that he has voluntarily executed this instrument, and
(iv) that he understands the contents and effect thereof.
As witness my hand this ......................... day of ............................, 20....................................
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Signature
SCHEDULE
Where the address of the person claiming under this instrument is outside the Federation, an
address within the Federation for the service of notices is to be added in this space.
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SCHEDULE OF LAND* AND INTEREST
*Town/ *Lot/Parcel/ Description Share of Registered No. Registered No.
Village/ L.O. No. and No. of land (if of *lease/ of Charge
Mukim Title any) sublease (if any)
(if any)
(1) (2) (3) (4) (5) (6)
*Delete as appropriate
**Not applicable in the case of a caveat binding a particular interest only
