Form 107

i have received letter from icai regarding articleship compleation i have taken 14 days excess leave as per the instruction i have to send 107 to the institute whether it should be executed on stamp paper and in that form in witness whereof parties hereunto set their hands the day and year first above written signed sealed and delivered in the presence of in the form they have given 3 colomn for this what is this?  kindly guide me through email prashanthm.1985 @ gmial.com