FORM 2

Requisition for a Certificate

(See Sec 5)

To
The Certificate Officer of District, Patna.

Name of the Address of the Amount of public Name of public

certificate debtor certificate demand for which demand for which
this requisition is requisition is
made made
Amrendra Kumar Amrendra Kumar 2,11,000 Agricultural Loan
Saxena Saxena, S/O Ram on KCC ( kisan
Janam Singh, credit card)
Village Berka,
Makhdumpur, P.O
Berka
Makhdumpur,
Distt Jehanabad,
PIN - 804408

I request you to recover the above mentioned sum of rupees 2, 11,000 which Im
satisfied, after enquiry is due from the said _____ in respect of agricultural loan
Verified by me on the ______ day of _____.

(Designation)