FORM PIM -1

(See rule 30 (4))

Application for the grant to permit for excavation of Bricks Earth by Bricks Kiln Owners

To,
The Assistant Mining Engineer / Assistant Geologist / Mining Officer,
Deptt. Of Mines and Geology,
Rohtak.
Dear Sir,
Undersigned intends to install a Bricks Kiln or is the owner of M/s Mahabir Bricks Company,
VPO Dobh, Tehsil & Distt. Rohtak for manufacturing of the Bricks rerequires the minor mineral
namely “Brick Earth”. The application fee of Rs. 500/- (non-refundable in the form of bank
draft / treasury challan bearing number, SBI Rohtak, Bank CIN NO. -________________, Rs.-
31750/- Dated - ___/____/_______is enclosed.

1) The details of the area for which permission is being sought is given under:-
(a) Location of Brick Kiln – VPO Dobh, Tehsil & distt. Rohtak.
(b) Category of the Brick Kiln – ‘zig zag’.
(c) Extent of the land from which brick earth is to be excavated – Rectangle no., Khsra no. is
Attached.
(d) Lay out plan of the area applied for permit – Attached.
(e) Existing status of the land as compared to general ground level of the area – 3 feet.
(f) Quantity of brick kiln required to be removed – 35 lac.
(g) Advance amount of permit fee/ royalty -- Rs. 31750/-.
(h) Security (refundable) – Rs. 7850/-.
2) Application further submits that;
i) Royalty at the rates prescribed under first schedule to the Haryana Minor Mineral
Concession, stocking & Transportation of Minerals and Prevention of illegal Mining Rules,
2012 shall be paid for the brick earth to be removed from the area under permit.
ii) Area is free from Section 4 and /or 5 of the Punjab Land Preservation Act 1900 and Aravalli
Project Plantation or any kind of forest.
iii) Digging of the earth at the site is otherwise not prohibited by any Court of Law or any
Authority.
iv) Brick earth will be used only for manufacturing of the bricks.
v) He will abide by all relevant provision for excavation of earth.
vi) Compensation has been settled with land owner mutually and a copy of the agreement
signed between the applicant and the land owner mutual settlement of the compensation is
attached (in case land is owned by the applicant himself, the proof thereof).
vii) In case of renewal of permit copy of last permit, along with proof of payment towards
applicable permit money of royalty.

Dated: ____/____/_______
Enclose: AS above. Brij Mohan Sharma s/o Chhattar Pal
VPO Sunari Kalan

Distt. Rohtak