Land Form5 Application For Conversion From Leasehold Out of Former Public Land To Freehold

Regulation 14
THE REPUBLIC OF UGANDA
THE LAND ACT, CAP 227
THE LAND REGULATIONS, 2004

Form 5
APPLICATION FOR CONVERSION OF LEASEHOLD OUT OF FORMER

PUBLIC LAND TO FREEHOLD
PART I: (To be filled by the applicant in triplicate)
1. Name Address Citizenship

................……………………..…………....... .............................. ..........................
.................………………………………........ .............................. ..........................
.................………………………………........ .............................. ..........................
………………………………………..…….. …………………. ……………….
2. Location of land the subject of application:

a) Village/Zone ……………………………………
b) Parish/Ward ……………………………………
c) Sub-county/Town ……………………………..
d) County/Division ……………………………….
d) District …………………………………………...
3. LRV ……………………………………….
Fol. ……………………………………….
Block ……………………………………….
Plot ……………………………………….
4. Approximate area (ha) ………………….
(number 5 and 6 to be filled only if the conversion concerns land exceeding one hundred
hectares.)
5. I/We wish to convert land in excess of one hundred hectares by ………………………….

(state amount in excess of one hundred hectares) and I/we wish the board to verify it.
6. Justification for grant of land in excess of 100 hectares

………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
Name and signature of applicant(s)

………………………………………….…..…. ……………………………..
……………………………………….………... ……………………………..
……………………………………….………... ……………………………..
Date of application ………………………………

DECLARATION
*I/We .................………………………………………………..... declare that the above particulars are

true to the best of my/our knowledge and belief and that the following conditions have been
complied with-
(i) that the leasehold is authentic and genuine;
(ii) that there were no customary tenants on the land at the time of acquisition (whose tenancy
was not disclosed)*;
(iii) that the customary tenants, who were on the land at the time of acquisition and whose
tenancy was disclosed, were duly compensated*;
(iv) that all development conditions and covenants have been complied with;
(v) that any other conditions imposed by law from time to time have been complied with; and
(vi) that the conversion is limited to one hundred hectares/that the conversion exceeds one
hundred hectares (*delete whichever is not applicable)
Name and Signature/Thumbprint of applicant(s)

.................................…………..……........ ...................................................
..................................……………..…....... ...................................................
...................................…………………..... ...................................................
Date ..............................................................
Declared before me, …………………………………………… …………..………….

Name and Signature
Commissioner for oaths
(Official Stamp)
Date .......................................
2
PART II
DECISION OF DISTRICT LAND BOARD
(Delete whichever is inapplicable)
A: Having considered the above application for conversion from leasehold into freehold of
land not exceeding one hundred hectares, the District land board:
a) is satisfied/not satisfied that the conditions provided under the Land Act Cap 227
and regulations made under it affecting conversion of leaseholds to freehold have been
complied with;
b) the verified area is………………. hectares

c) it is in the public interest/not in the public interest to convert the leasehold land in
excess of 100 hectares which is the subject of the application to freehold.
B: The application for conversion is –

a) approved
b) not approved
C: Reasons for decision

………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
D: Minute number
…………………………………………………………………………………………..
………………………………………………………………………………………….
…………………………………………………………………………………………..
Official Seal
………………………………………………. ……………………………………….
Name and signature of the Name and signature of the
Secretary, district land board Chairperson, district land board
Date ............................….......
* The board shall send a copy of this form to the office of titles for issuance of a certificate in
accordance with section 13 (6) of the Act.

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Regulation 14

THE REPUBLIC OF UGANDA

THE LAND ACT, CAP 227

THE LAND REGULATIONS, 2004

APPLICATION FOR CONVERSION OF LEASEHOLD OUT OF FORMER

PART I: (To be filled by the applicant in triplicate)

1. Name Address Citizenship

2. Location of land the subject of application:

4. Approximate area (ha) ………………….

5. I/We wish to convert land in excess of one hundred hectares by ………………………….

6. Justification for grant of land in excess of 100 hectares

Name and signature of applicant(s)

Date of application ………………………………

*I/We .................………………………………………………..... declare that the above particulars are

(i) that the leasehold is authentic and genuine;

Name and Signature/Thumbprint of applicant(s)

Declared before me, …………………………………………… …………..………….

DECISION OF DISTRICT LAND BOARD

(Delete whichever is inapplicable)

b) the verified area is………………. hectares

B: The application for conversion is –

C: Reasons for decision

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