Appendix F — Form for Occupancy Certificate

Reference number: ________________________
Permit number: __________________________
Address of the site:
Plot number: ____________________________            Holding number: _____________
Dag/Khatian number: ____________________             Mouza/Block/Sector: __________
Street name: ____________________________            Municipal ward number: ________
Documents enclosed along with this form:
                           ______________________
                           ______________________

Type of work (Check one) Develop Erect Demolish Alter

Name of the owner:         _______________________________________
Contact address:           _______________________________________
                           _______________________________________
                           _______________________________________
Post code:                 ____________________
Telephone no:              ____________________

I hereby certify that the work having the above mentioned detailed particulars has been
completed in accordance with the plan and design approved by the permit number cited
and the provisions of the Bangladesh National Building Code. The owner has submitted
all the required documents for issuance of occupancy certificate. Thus, I, hereby, certify
that the holding may be occupied as ___________________________________ (mention
the occupancy type).

________________________
  Signature of the Officer

________________________                        ____________________________
    Name of the Officer                                  Official stamp

________________________                        ____________________________
       Designation                                           Date