ee NGWaTO LAND BOARD APPLICATION AND GRANT OF FIELD/ PROJECT WATER POINT 1 (Full Name) of Box Phone Hereby apply for licld/Project water point in a feld/nres that have been granted at (Location) this field has been duly allocated 10 me by (Sub Land board) on (Date) Signed by - on this day of Month... Year Omang No — 0 Sub Land Board's Comments on Recommendation Approved |_] Rejection [_ ] Name... Designation Date: ~- Chairman/Board Clerk Verification and approved/Rejection by Land board Chatrman/Board Secretary Approved O Rejection O - Name. Designation Copy of field cenificate/Lease must be anached Any breach of te above condition will lead to cancelation of the grant vy THIS form must be filed in mipicate