FORM -1 A

(Rule 6)
Application for digging / drilling a well / borewell for agricultural
and Drinking water use
1. Name of the Applicant

______________________________

2. Address of the Applicant

______________________________
______________________________
______________________________

3.Location of proposed borewell, Property

______________________________
______________________________

Khatha No. / ward no.

______________________________
______________________________

(With complete address & RR No. of BWSSB

water supply/sanitary connection if any)
4. Purpose of digging / drilling well/ Borewell

(Agricultural/drinking water use)

______________________________

______________________________

6. Distance from existing functional well/borewell :

______________________________

5. Existing status of water supply

And public borewell
7. Details of payment
a) Survey Charges
b) Copy of paid challan
c) Branch of Canara Bank

Rs. 50/-

:
:

______________________________
______________________________

I hereby declare that the above particulars are true to the best of my knowledge and belief.
Place

Date

Signature of the Applicant

Note: The amount of Rs.50/- shall be deposited at any branch of CANARA BANK, Bangalore to the
current A/C No.0788201052332 and the copy of paid challan has to be enclosed with the application.
_______________________________________________________________________________________
ACKNOWLEDGEMENT
An application for digging / drilling a new well / borewell for agricultural / drinking water use
is received in this office along with an application fee of Rs.50/- paid at ___________________branch,
Canara Bank Dated______________ from Sri/Smt___________________________.
Place
Date

:
:

Signature of Designated Officer

Karnataka Ground Water Authority
1

FORM -1 B
(Rule 6)
Application for digging / drilling a well / borewell for Industrial / Commercial,
Entertainment or other use
1. Name of the Applicant
: ______________________________

2. Address of the Applicant

______________________________
______________________________
______________________________

3.Location of proposed borewell,

Property/

Khatha No. / ward no.

______________________________
______________________________
______________________________
______________________________

(With complete address & RR No. of BWSSB

water supply/sanitary connection if any)

______________________________

______________________________

6. Distance from existing functional well/borewell :

______________________________

4. Purpose of well/ Borewell

(Industrial, commercial, Entertainment, sale of
Water through water tanker)
5. Existing status of water supply
And public borewell
7. Details of payment
d) Survey Charges Rs.

: ______________________________

e) Copy of paid challan

f) Branch of Canara Bank

Rs.500/-

______________________________

I hereby declare that the above particulars are true to the best of my knowledge and belief.
Place

Date

Signature of the Applicant

Note: The amount of Rs.500/- shall be deposited at any branch of CANARA BANK, Bangalore to the
current A/C No.0788201052332 and the copy of paid challan has to be enclosed with the application.
_______________________________________________________________________________________
ACKNOWLEDGEMENT
An application for digging / drilling a new well / borewell for Industrial, Commercial,
Entertainment or other use purpose is received in this office along with an application of Rs.500/paid at ________________ branch, Canara Bank Dated________ from Sri/Smt__________________.
Place
Date

:
:

Signature of Designated Officer

Karnataka Ground Water Authority
2

FORM -4
(Rule 7)
Application for registration of existing user

1. Name of the Well/Borewell owner

2. Address

:
:
:
:

3. Well / Borewell location with

Property no. / Khatha No / ward no. area
(BWSSB R.R. No. of existing water supply
/ Sanitary Connection if any)
4. Type of well (Open Well / Borewell)
i) Open Well / Borewell Diameter
ii) Open Well / Borewell Depth
iii) Yield (Gallons per Hours)
iv) Hand pump / power pump
a) Type of pump: Submersible / Jet/
Compressor / centrifugal / turbine
b)Capacity (HP/Stages)
c) BESCOM R.R. No.
v) Use of water
a) Domestic
b) Non domestic Industrial/commercial/
Entertainment / sale of water through
water tanker /others.
5. Payment details
a) Registration charges
b)Copy of paid challan
c) Branch of Canara Bank

:
:
:
:
:
:
:
:
:

____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________

____________________________________
:
____________________________________
:
____________________________________
:
____________________________________

:
:

____________________________________

____________________________________
____________________________________
____________________________________

I hereby declare that the above particulars are true to the best of my knowledge and belief.
Signature of the User
Note: Separate application has to be submitted for each well / borewell along with registration fee of
Rs.50/- for agricultural / drinking water use and Rs.500/- for Industrial / Commercial / Entertainment
or other uses, The amount shall be deposited at any branch of CANARA BANK, Bangalore to the current
A/C No.0788201052332 and the copy of paid challan has to be enclosed with the application.
_____________________________________________________________________________________________
ACKNOWLEDGEMENT
Application for registration of existing well / borewell is received in this office along with
registration fee of Rs._________ paid at ________________ branch, Canara Bank Dated________.

Place
Date

:
:

Signature of Designated Officer

Karnataka Ground Water Authority

FORM -6
(Rule 8)
Application for registration of Drilling Agency
1. Name of the Applicant / Agency

: _________________________________

2. Address (with Phone No.)

: _________________________________
: _________________________________
: _________________________________

3. Status
(Individual / HUF/ Proprietorship / Partnership)
4. Agency current registration details (with document)
(As per Karnataka Registration Act)
5. If Partnership Agency / Firm
(Details and responsibilities of each partners)

: _________________________________
: _________________________________
: _________________________________
: _________________________________
: _________________________________

6. Drilling unit
i) Owner / Lease (Enclose document)

: _________________________________

ii) Vehicle Registration details (RC to be enclosed)

: _________________________________

iii) Make of the compressor / drilling machine

: _________________________________

iv) Capacity of the compressor (PSI)

: _________________________________

(Fitness letter from the manufactures to be enclosed)

v) Area of Operation
7. Qualification & experience of the driller

: _________________________________
: _________________________________
: _________________________________

8. Previous five years work details

a. Number of borewells completed

: _________________________________

b. Private / Government / Local Authority

: _________________________________

c. Audit Report / IT Returns

: _________________________________

9. Registration Fee

: Rs._______________________________

i) Copy of paid challan

: _________________________________

ii) Branch of Canara Bank

: _________________________________
Signature of the Applicant

Note: Separate application to be submitted for each drilling rig along with the prescribed fee of
Rs.5000/- and shall be deposited at any branch of CANARA BANK, Bangalore to the current A/C
No.0788201052332 and the copy of paid challan has to be enclosed with the application.
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