Form LRA 67 (r.
80(1)
REPUBLIC OF KENYA
THE LAND REGISTRATION ACT
THE LAND REGISTRATION (GENERAL) REGULATIONS, 2017
Date Received Presentation Book Official
Fees Paid
…………………….. No. …………………. Kshs.
CAUTION
TITLE NUMBER: ……………………………………
Date of Caution
The Cautioner
ID/Passport No.
Registration No. of the Cautioner
(if any)
Address of the Cautioner (within
Kenya for service of Notice)
The Proprietor
ID/Passport No.
Registration No. of the Cautioner
(if any)
PIN Number
Citizenship/Place of registration.
Address of the Proprietor (within
Kenya for service of Notice)
Interest Claimed
Extent or Scope of the Caution
(Absolutely/subject to the
interest of the Cautioner
1. The Cautioner HEREBY APPLIES for registration of a Caution over the
above Title to the extent of scope stated above.
2. The Cautioner forbid the registration of dealings and the making of entries
in the register relating to the Title to the extend or scope of the Caution
without the Cautioner’s consent until this Caution has been withdrawn by
the Cautioner or removed by order of the Court or the Registrar.
3. The Cautioner hereby attaches the following document to support of the
application:
(i) …………………………………………………………………………………………
(ii) ………………………………………………………………………………………….
(iii) …………………………………………………………………………………………
IN WITNESS the Cautioner has signed this Caution.
EXECUTION:
SIGNED by the Cautioner in the
Presence of:-
Coloured
Photograph
ID/No. ………………………………………..
PIN No. ………………………………………
Signature:
……………………………………..
Certificate of Verification
I CERTIFY that the above-named ……………………………………………
appeared
before me on the ………………day of ………………………………………..2020
and being known to me/being identified by ………………..…..of
………………………. acknowledge the above signatures or marks to be
his/hers and that he/she had freely and voluntarily executed this
instrument and understood its contents.
…………………………………………………
Signature and Designation of Person Certifying
REGISTERED and SEALED this ………………………… day of ………………..20………
Seal……………………………………………………….
LAND REGISTRAR
Name:
Signature:
*Copies of Sale Agreement, Letters of Administration, Letter of Offer
etc.
STATUTORY DECLARATION
I, …………………………………………..(in support of this caution) do hereby
sincerely declare as follows:
…………………………………………………………………………………………………….
…………………………………………………………………………………………………….
…………………………………………………………………………………………………….
…………………………………………………………………………………………………….
…………………………………………………………………………………………………….
…………………………………………………………………………………………………….
I make this declaration conscientiously believing the same to be true and
according to the Oaths and Statutory Declaration Act.
DECLARED before me at ………………………….
on this ……………..day of ………………..20…..
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………………………………………………………..
Signature of Advocate of Land Registrar
