Application for License/Renewal
Under Rule 3(a) and 4(a)
Download Form-A User Manual

I) Type of Application

II) Status of the applicant

Name of the Applicant
Firm Type
Name of Proprietor
Name of Managing Partner
Name of Father
Door No
PAN Number  
Aadhar Number
- -
Mobile Number
Email ID
Electricity Connection number

IV) Status of the applicant

a)   i. Nationality
ii. Qualification
iii. Experience in Mining field(in Yrs.)

b) Profession or Nature of the Business of the Applicant  *

III) Ores or Minerals for which License is applied for.
  ( In Case of Multiple Mineral, Press Ctrl or Shift Key and Choose )

V) Purpose of the License.*
  ( In Case of Multiple Purpose of License, Press Ctrl or Shift Key and Choose )

VI) Period of License  *

VI) Details of the area in respect of which License is required *

Survey No
Extent (In Hectares)
Land type*
Land Ownership Type*
Land Certificate (Upload as png/jpeg/jpg/pdf format.)*
Plot/Patta/Door No
Latitude N
° ' ''
Longitude E
° ' ''

VII) Income Tax returns for the last 3 years.*

VIII) GST/VAT registration No *

IX) GST/VAT registration No and Jurisdiction Document (Upload as png/jpeg/jpg/pdf format.)*

X) Affidavit showing the details of Mining/Quarry Leases and mineral based industries held within state by applicant or its partner. (Upload as png/jpeg/jpg/pdf format.)*

XI) Photo of the Applicant (Upload as png/jpeg/jpg format.)*

XII) Signature of the Applicant (Upload as png/jpeg/jpg format.)*

XIII) PAN Card No (Upload as png/jpeg/jpg format.)*

XIV) Aadhar Card No (Upload as png/jpeg/jpg format.)*

XV) Affadivit, duly notarized, to the effect that the applicant had not been convicted under M.M(D & R) Act 1957 and the rules made there under. (Upload as png/jpeg/jpg/pdf format.)

XVI) Other Documnets (like article of memorandum, letter for change of directors, partners in case of firms, companies etc..) (Upload as png/jpeg/jpg/pdf format.)

a)Document Name :

b)Document Name :

c)Document Name :

   I/We hereby declare that I/We have read and understood all the provisions of the A.P Mineral Dealer Rules, 2017 made there under and the conditions of the License and I/We agree to abide by the same . *