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) Purpose of Mineral Used For.*

VIII) 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.
 


XI) Name of the Mineral applied.*(Note : Please Add atleast one mineral with Quantity and Unit)

 


X) Mineral requested quantity for permit. *

Quantity  *
Unit  *


 

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

 

° - ' - ''

° - ' - ''




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 (Upload as png/jpeg/jpg format.)* *

XIV) Aadhaar Card (Upload as png/jpeg/jpg format.)* *

XV) Upload Affidavit duly notarized for MRCC (Upload as png/jpeg/jpg/pdf format.)* *

XVI) Affidavit duly notarized for ITCC(Upload as png/jpeg/jpg/pdf format.)* *

XVII) Applied area sketch (Upload as png/jpeg/jpg/pdf format.)* *

XVIII) If obtained NOC for Competent Authority *

obtained NOC for Competent Authority (Upload as png/jpeg/jpg/pdf format.)* *






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