APPLICATION FORM FOR TEMPORARY PERMIT

I) Type of Application  *

II) Details of the applicant

III) Residence/Firm/Company Address

Door No  *
 *
 *
State  *
District   *
Mandal   *
Village *
Pincode  *
PAN Number  *
Aadhar Number *
- -
Mobile Number  *
Email ID  *

IV) Permanent Address

Door No  *
Street  *
Country  *
State  *
District   *
Mandal   *
Village *
Pincode  *

V) Representative Details

 
 
 
Email ID  

VI) Work Details

A) Name of the Work Awarded *
Name of the Department *
Work order Number *
Work order Date  * (MM/DD/YYYY)
Date of estimation to complete the work  * (MM/DD/YYYY)


B) Purpose of Mineral Used For.*


C) Upload Work Order Copy  *

VII) Details of the area in respect of which Permit is required

Survey and Range Details *

Survey No  *
Extent (In Hectares) *
Range  *
District  *
Mandal  *
Village  *
Land type*
Plot/DKT No.
 


VIII) Name of the Mineral applied.*

 


IX) Mineral requested quantity for permit. *

Quantity  *
Unit  *

(Note : Please Add atleast one mineral with Quantity and Unit)

 

X) Geo co-ordinates of the area (Minimum 3 entries) *

 

° - ' - ''

° - ' - ''




XI) Upload Photo of the Applicant*

XII) Upload Signature of the Applicant*

XIII) Upload PAN Card *

XIV) Upload Aadhaar Card *

XV) Upload Affidavit duly notarized for MRCC *

XVI) Upload Affidavit duly notarized for ITCC *

XVII) Upload Applied area sketch *

XVIII) If obtained NOC for Competent Authority *

Upload obtained NOC for Competent Authority *






   I declare that the above particulars are correct and request that a Temporary Permit may kindly be granted. *