¹ô âô¢¬ô Ü÷ Ü è£ì¢ìè¢ «è£¼õîø¢è£ù õ¤í¢íð¢ðñ¢

(APPLICATION FOR POINT OUT FIELD BOUNDARY LINE)
***
Affix here Court fee Stamp
forRs.2/Ï.2/-è¢è£ù ï¦î¤ ñù¢ø èì¢ìí
õ¤ô¢¬ô¬ò Þ颫è åì¢ì¾ñ¢
1.

2.

3.

4.

õ¤í¢íð¢ðî£óó¢ ªðòó¢
Name of the Applicant

:

îèð¢ðù£ó¢ / èíõó¢ ªðòó¢
Father / Husband's Name

:

Þ¼ð¢ð¤ì ºèõó¤
Residential Address

:

¹ô âô¢¬ô Ü÷ è£ì¢ìè¢ «è£¼ñ¢ ªê£î¢¶ ðø¢ø¤ õ¤õóñ¢
Details of Land to be pointed out field boundary
:
ñ£õì¢ìñ¢
District

:

õì¢ìñ¢
Taluk

:

è¤ó£ñî¢î¤ù¢ ªðòó¢
Name of the Village

:

ð°î¤ âí¢
Block Number

:

ïèó Ü÷¬õ âí¢ - ñÁ ï¤ô Ü÷¬õ âí¢
Town Survey Number/ Re-Survey Number

:

à÷¢Ùó¢ ð°î¤ / ïèóî¢î¤ù¢ ªðòó¢
Name of the Local Area or Town

:

ªî¼õ¤ù¢ ªðòó¢
Name of the Street

:

èî¾ âí¢
Door No.

:

ñ¬ùð¢ ð¤ó¤¾ ñ¬ù âí¢
Lay out Plot No.
ðóð¢ð÷¾

:

Extent

:

?2?
5.

6.

ªê£î¢¶ ñÂî£ó¼è¢°ê¢ ªê£ï¢îñ£ù¶
âù¢ðîø¢è£ù Ýî£ó Ýõíé¢è÷¤ù¢
ê£ù¢ø÷¤è¢èð¢ðì¢ì ïèô¢è÷¢
Þ¬íè¢èð¢ð좴÷¢÷î£?
(ðî¢î¤ó ïèô¢ / ðì¢ì£ ïèô¢ ºîô¤òù)
Whether attested copy of document
for proof that property belongs to
the applicant is enclosed?

:

å¼ ¹ô âô¢¬ôè¢ «è£ì¢®ø¢°
Ï.10/- õ¦îñ¢ (°¬øï¢î ðì¢êñ¢ Ï.40/-)
¹ô âô¢¬ô Ü÷¾è¢ èì¢ìíñ¢
ªê½î¢î¤ò õ¤õóñ¢ (êô£ù¢ âí¢ / ï£÷¢ /
ªî£¬è / ªê½î¢î¤ò õçè¤ /
è¼×ôî¢î¤ù¢ ªðòó¢)
Specify remittance Details
of Field Boundary line measurement fees
Chalan No, Date, Amount & Place
and Name of the Treasury or Bank

:

àÁî¤ ªñ£ö¤ - Declaration

/
ñî¤/////////////////////////////////////î/ªð
(Ü)
è/ªð////////////////////////////////// Ýè¤ò
ï£ù¢
Ãø¤ò
õ¤õóé¢è÷¢
ò£¾ñ¢
àí¢¬ñò£ù¬õ âù¾ñ, ¹ô âô¢¬ô Ü÷ è£ì¢ìè¢ «è£¼ñ¢ ªê£î¢¶ âù袰
ªê£ï¢îñ£ù¶ âù¾ñ¢ ¹ô âô¢¬ô Ü÷ è£ì¢ìè¢ «è£¼ñ¢ ªê£î¢¶ ªî£ìó¢ð£è
ï¦î¤ñù¢ø î£õ£ ⶾñ¢ 綠¬õò¤ô¢ Þô¢¬ô âù¾ñ¢, ï£ù¢ Ãø¤»÷¢÷
îèõô¢è÷¤ô¢ ã«îÂñ¢ îõø£ù îèõô¢è÷¢ Þ¼ð¢ðî£è ð¤ù¢ï£÷¤ô¢ ªîó¤òõï¢î£ô¢,
âù袪èî¤ó£è àó¤ò êì¢ìÌó¢õ ïìõ®è¢¬è «ñø¢ªè£÷¢÷ð¢ð´ñ¢ âù¢ð¬î ªîó¤ï¢¶
ªè£í¢«ìù¢ âù¾ñ¢ Þîù¢ Íôñ¢ àÁî¤ ÃÁè¤ù¢ø«ù¢.
I
……………………………..S/O
or
D/O
…………………………………………. is hereby declare that
(1) The above-mentioned particulars are correct to the best of my knowledge,
(2) The property is under my enjoyment, and it is my own property
(3) There is no any Court case pending.
(4) Legal action may be taken against me if any particulars given above are
come to know as false in future
Þìñ¢ -Place
ï£÷¢ -Date

:
:

ñÂî£óó¤ù¢ ¬èªò£ð¢ðñ
Signature of Applicant

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