E-Pass Book Application Form

Service Type*:
New Pattadhar Pass Book

Duplicate Pattadhar Pass Book

Replacement of Pattadhar Pass Book

Land Details:-

District *: _________________Mandal *: ___________________Village*: ________________ Khata No*: ________

Pattadhar Details:-

Caste Category *: _________________Caste Name *: __________________Division Name*: _______________

Reasons for Pattadhar Pass Book*: ______________________________________________________________________
For Duplicate/Replacement of Pattadhar Pass Book
Old Pattadhar Pass BookNo *: _________________Registration No *: __________________Registration Date*: ________

Applicant Details:-

Applicant Name *: ______________________________Relation *: _________________________Gender*: _________

Date of Birth: _____________________

Permanent Address:-

State*: ____________________Door No: _________________ Locality/Land Mark: ____________________________

District*: ____________________ Mandal*: _____________ Village/Ward*: _________________Pin Code: _________

Postal Address:-

Door No: _________________ Locality/Land Mark: _______________________________________________

State*:_____________________District*: _________________________ Mandal*: ____________________

Village/Ward*: ____________________Pin Code: _________________Mobile Number*: __________________

Phone: ___________________Email ID: _________________Ration Card No: ___________________

Remarks: ___________________________________________________________________________________

Delivery Type*:
Postal

Document List: - (NOTE: All Upload Documents are in PDF format only and All Documents Size must not exceed 3MB)

For New Pattadhar Pass Book:

 Application Form *
 Tax receipts if any *
 Old Pattadar Passbook *
 Registered document (copies) *
 Buyer Recent passport size photo * (In .JPG Format Only)
 Buyer Signature * (In .JPG Format Only)

For Duplicate Pattadhar Pass Book:

 Application form *
 Scanned Copy FIR*
 NOC certificate from the bank in the respective jurisdiction *
 Registered Document (Copies) if any*
 Recent pass port Size photo*(In .JPG Format Only)
 Signature * (In .JPG Format Only)

For Replacement Pattadhar Pass Book:

 Application form*
 Registered Document (Copies) if any*
 Recent pass port Size photo*(In .JPG Format Only)
 Signature* (In .JPG Format Only)

Applicant’s Signature