FORM - A

Application For Carrying Out The Soil Conservation Work

1. Name of the Applicant (in Block :

Letters)

2. Father’s/Husband Name :

3. Address in full :

4. Field in which Soil Conservation works :

is to be taken

5. Village :

6. Tahsil :

7. Type of Soil :

8. Whether Cleared Yes/No:

9. If cleared when ? :

10. Encumbrances on field :

11. Type of tenure :

Declaration

I agree to abide by the rules and regulations of Soil Conservation Scheme to execute the bond in the
prescribed form before the excavation of work for the actual cost that may be incurred in implementing
the scheme as per the direction of the Soil Conservation Officer.

Signature of the Applicant

To
The Soil Conservation Officer,
Directorate of Agriculture,
Port Blair.