ACKNOWLEDGMENT OF RIGHT TO ARREARS OF LICENCE FEES UNDER A LICENCE

I, _______________, S/o Sh. _____________, R/o __________________ hereby acknowledge that I owe to Sh. ___________, S/o Sh.___________, R/o _________________ as arrears of licence fees from ________ to _________ under a Licence dated _____ in respect of the factory situated at __________.

Dated: ________

(Signed) _____________

Address: ____________

[There are several forms in which an acknowledgment may be made by way of a mere receipt or an agreement. Where there is any question relating to any right in immovable property, suitable form may be adapted.]