REGULARIZATION OF ENCROACHMENT IN GOVERNMENT LAND UPTO 500 Sq.

Yards

Applicant/ Occupant Details:

AADHAR Card No:____________________ Applicant Name*:_______________________________________

Gender*: ____________________________ Age*: _________________ Category*:
APL
BPL

Father/ Husband Name*: _______________________ Social Status *:
SC
ST
BC
Minority
OC

Residential Address*: _______________________________________________________________________

_________________________________________________________________________________________

Proof of Occupation*:
Registration Documents
Property Tax Receipt
Electricity Bill
Water Tax

Receipt
Others. (If Others ______________________)

Proof of Identity Name*:
Aadhaar Card
Ration Card
Voter ID Card
Others

Proof of Identity No*: ______________________________________________________________________

Whether any encroachments were regularized for him/her or his/her spouse previously*:
YES
NO

If YES, details of regularization *: _____________________________________________________________

Whether the applicant/ his spouse has own house*:
YES
NO

If YES, details address of own house*: _________________________________________________________

Service Specific/ Government Land Occupied Details:

Woman member name in whose name assignment order /house site Patta to be issued*: ______________

_________________________________________________________________________________________

Extent of Land Occupied*(in yrds): ________ Date from which occupied*(dd/mm/yyyy): _______________

Land Mark of Area*: __________________________ District*:______________________________________

Municipality/ Mandal*: ____________________________ Village / Ward *:__________________________

Construction Type*:
RCC Roof
Asbestos Roof
Tiled Roof
Others Pin code*:_________________

Informant Details:
Informant Name*: _____________________________ Relation with Applicant*: ______________________

Mobile No*: ___________________________ Delivery Type*:
Manual
Local Post
Non Local Post

Postal Address: (If Delivery is Local Post/ Non Local Post)

House No*:____________ Street*:_________________________ District*: ___________________________

Mandal*: ____________________ Village/ Ward*:____________________________ Pin Code*: _________

Documents List:
(NOTE: All Upload Documents should be in PDF Format only and the size should not exceed 3 MB)

1. Application Form*
2. Proof of Identity*
3. Proof of Occupation*
4. Photograph of Occupant along with the constructed Building in dwelling units*

Applicants Signature