| 1.(a)Name of the applicant
- |
a.Age - |
| 2.Father’s Name |
------------------------------- |
| 3.(a)Present residential
address (in full) |
------------------------------- |
| a.Permanent home address
(in full) |
------------------------------- |
| 4.Caste, Whether
S.C./S.T/others. |
------------------------------- |
| 5.Number of family
members |
------------------------------- |
| 6.Whether belongs to joint
family or Member of single family. |
------------------------------- |
| 7.Annual income |
------------------------------- |
| a.From
Agriculture |
------------------------------- |
| b.From other
sources |
------------------------------- |
| 8.Extent of land owned by
him in his name |
------------------------------- |
| 9.Or in the name of other
members of his Family in Urban Area/Rural Area |
------------------------------- |
| 10.Occupation of the
applicant |
------------------------------- |
| 11.Occupation of the
family members |
------------------------------- |
1.Detailed particulars of
land applied for
- Name of village/Name of urban
area
- Holding number, if any
- Plot number, if any
- Area applied for
- Boundary
|
|
| 1.Purpose for which the
land is required |
|
| Date
: |
Signature of the
Applicant
|