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Appendix IV

Appendix IV
[See Rule 11(8) and 16 (1)]
Application for assignment of Land on Registry, Lease or Licence.


1. Name of applicant
2. Present address
3. Previous address (Full address)
4. Survey number if the land applied for
5. Extent
6. Boundaries
7. Nature of the land
8. If there is occupation of the land applied for, the year from which the land was occupied.
9. Total extent under occupation
10. If held on lease details there of such period of lease, year from which the lease was sanctioned and the lease amount.

1. Substituted by SRO 41/70 pub. in K.G. Ex. No. 34 dt.21-01-1970.
2. Inserted by SRO 41/70 dt.21-10-1970 were Substituted by SRO 489/76 dt.08-04-1976.

11. Total extent of land (other than Government land) held by the applicant or members of his family either in proprietary right or with security of tenure.
12. Annual income of the family from source other than Government lands.
(To be filled up in the case of Application for concessional Registry).
13. Whether Scheduled Caste or not, if Scheduled Caste (indicate caste also),
14. Occupation

Declaration


I do hereby declared that the details furnished in the application are correct and that I do not own any land either in proprietary right or with security of tenure except as shown above and that my annual income from all sources is Rs.
Place:
Date: ..................................................................................Signature of applicant