Revenue Handbook

Table of Contents
Sl No Name of the Section Form Application Forms Page

No
1 Odisha Miscellaneous
Certificates
1 Application form for Residence Certificate 5-6
2 Application form for Legal Heir Certificate 7-8
3 Application form for Income Certificate 9-10
4 Application form for Solvency Certificate 11-12
5 Application form for Guardianship Certificate 13-14
7 Residence Certificate Format 15
8 Legal Heir Certificate Format 16
9 Income Certificate Format 17
10 Solvency Certificate Format 18
11 Guardianship Certificate Format 19
12 Proclamation Format 20
2 Mutation 13 Application form for mutation 21-22
Applicant Details
Schedule of Property
Documents Relied
14 Register of mutation reported to Tahasildar 23
15 Court Fee Register and Daily Total 23
16 Mutation Register 24
17 Forms of General Notice 25
18 Form of Individual Notice 26
19 Register of process made over to the Nazir for service 27
20 Mutation case objection petition register 28
21 Register of Attendance of witnesses in Revenue Court 28
22 Register of measurement and mutation fees 29
23 Amins Enquiry report form 30
24 Intimation Slip 30
25 Register of Change (A &B) 31
26 Register of Appeal in Mutation case 32
3 Special Survey and 27 From 1 – Form of Proclamation 33
Settlement
28 Form 2 – Form for Self Declaration 34
29 Form 3 – Form for Verification Certificate issued 35
against Self Declaration
30 Form 4 – Form for Registered Un- Verified lands 36
31 Form 5 – Abstract of record of Rights 37
32 Form 6 – Form of plot Register 38
33 Form 7 – Form of Preliminary Record of Rights 39
34 Form 8, 9 – Form of Claim and Objections 40
35 Form 10 Form of Register of Claim and Objection 41
36 Form 11 - Form of Notice 42
37 Form 12 – Form of Draft RoR 43
38 Form 13 – Form of Notice Inviting Claims/ Objection 44
during publication
40 Form 14- of Filing Claim and Objection 45
41 Form 15 - Form of register of Claims / Objection filed 46
during draft publication
42 Form 17 – Form of Notice to parties for hearing of 47
Claims / Objections during draft Publication of RoR
43 Form 18 – Form of Abstract of new RoR 48
44 Form 19 – Form of New plot Register 49
45 Form 20 – Form for final publication of RoR 50
46 Form 21 – Form for filing Claims/ Objections 51
47 Form 22 – Notice to parties for hearing of Claims/ 52
Objections
4 OGLS (Orissa Govt 48 Application for settlement of Govt. land for Individuals 53
Land Settlement)
49 Form II- Form of Register 54
50 Form- III Proclamation Office of Tahasildar 55
51 Form IV- Intimation Slip For Settlement of Lands 56
52 Schedule I- Affidavit 57-58
53 Power to Sanction Settlement of Government Land 59-60
54 Rules For Allotment of Government Lands in the Civil 61-75
Township of Rourkela Notified Area
55 Application for Settlement of Gramakantha Parambok 76
and Abadi Land
56 Standard form of lease deed for lease of Khasmahal, 77-79
Nazul, Gramakantha Parambok and Abadi lands used
for purposes other than homestead in urban area
57 Standard form of lease deed for lease of Khasmahal, 80-82
Nazul, Gramakantha Parambok and Abadi land used
for homestead purposes in urban area.
5 OPLE(Orissa 58 Form A-Notice for unauthorised occupation 83
Preservation of Land
Encroachment)
59 Form B-Notice for eviction 84
60 Form C-Prohibited order against construction 85
61 Form D-warrant of arrest 86
62 Form E-Undertaking in the court 87
63 Form F-Intimation slip for settlement of land 88
64 Form G-Report for RI 89-90
65 Form H-Resister of encroachment 91
66 Form I-Register showing govt. lands likely to be 92
required for any development scheme
67 Form J-Settlement of land 93
6 Registration 68 General Search Application 94
69 Form No 23-Application for search or inspection 95
70 Application 25- Nil certificate for Encumbrance on 96-97
Property
71 Application 26-Certificate for Encumbrance on 98-100
property
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72 Form No 27- Certificates showing list of documents 101-102
exhibited by a person
73 Notice of intended Marriage 103
74 Application for Registration of Marriage 104-105
7 Land acquisition 75 Form A-Proposal for land acquisition 104-106
76 Form B-ToR for the SIA 107
77 Form C-Notification U/S 4(1) 108-109
78 Form D-Detail of SIA studies 110-113
79 Form E-Social impact management plan 114
80 Form F-Socio economic and cultural parameter 115-116
81 Form G-Key impact areas 117-119
82 Form H-Preliminary Notification U/S 11(1) 120-121
83 Form I-Declaration U/S 19(1) 122-123
84 Form J-Prior written consent 124
85 Form K-Land acquisition award 125
86 Form L-Award for R&R 126
87 Form M-Format for gram shava resolution 127
8 OMMC 88 Form F-Intimation to successful reader 128
89 Form H-Intimation for opening/reopening of mine/ 129
quarry
90 Form M-Application for grant for lease quarry 130-131
91 Form N-Quarry lease 132-134
92 Form O-Preparation of mining plan for quarry lease 135-137
93 Form P-Quarterly return of minor minerals 138-139
94 Form Q-Application of quarry permit 140
95 Form R-Grant of quarry permit 141
96 Form S-Particulars of quarry permit 142
97 Form T-Register of quarry permit 143
98 Form V- Resister of mining lease 144
99 Form W- Register of quarry lease 145
100 Form X- Form of appeal 146
101 Form Y- Transit pass for mining minerals 147
102 Form Z- Annual return by competent authority 148
9 OPDR 103 Form No-13 Order on the Nazir for causing publication 149
of Proclamation of Sale
104 Form No-14 Certificate by the officer holding a sale of 150
the deficiency of price on a resale of property by resign
of purchase of default
105 Form No-15 Certificate of sale of land 151
106 Form No-16 Odder for delivery to certified purchaser 152
of land at a sale in execution
107 Form No -17 Register of certificate 153-154
108 For No-18 Notice to pay 155
109 Form No-19 Attachment in execution 156
110 Certificate of public demand 157
111 Requisition of Certificate 158
112 Notice to Certificate Debtor 159
113 Petition denying liability 160
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114 Notice to Show caused why sale should not be set 161
115 Warrant of arrest 162
116 Order committing certificate-Debtor to Civil Prison 163
117 Notice to legal representative of Certificate Debtor 164
118 Notice to Certificate Holder 165
119 Warrant of sale of Property 167
120 Notice for sale Proclamation 168-169
10 OGFR 121 Form OGFR-2 Joining / Relieving 170
122 Form OGFR-3 Application for Leave 171-172
123 Application for withdrawal from GPF 173-175
124 Sanction of deputation 176
125 Fixation of pay 177-184
11 Departmental 126 Memorandum of Charge ( Rule 15) 185
Proceeding
127 Article of charges 186
128 Imputation in support of charges 187
129 Memo of Evidence 188
130 Departmental Proceeding Under Rule 16 189
12 Odisha land Reforms 131 Application of a Raiyat for Conversion of Agricultural 190
Lad for Non-Agricultural Purpose
132 Application for being declared as a raiyat under clause- 191
h of Sub-section (1) of section 4
133 Application for being declared as a raiyat under Clause 192
(i) of Sub-section (1) of Section 4
134 Notice of landlord giving particulars of transfer of a 193
holding a raiyat or portion or share thereof
135 Notice of partition of a holding made by a registered 194
instrument
136 Notice of partition of a holding made by a decree of a 195
Court
137 Notice of partition of a holding made by an order of the 196
Revenue Officer
138 Application by landlord for determining the resumable 197
and the non-resumable Lands
139 Application by tenant for issue of a certificate 198
determinant resumable and the non-resumable lands
140 Certificate specifying the resumable and the non- 199
resumable lands
141 Form -9 200
142 Application for a certificate regarding incapability to 201
cultivate land personally
143 Certificate regarding incapability to cultivate 202
personally
144 Application for being declared as a raiyat under Sub- 203
Section rule (1)(a) of Section 19
145 Application for surrender of abandonment of land by a 204
raiyat or tenant under Sub-section (2) of Section 22-A
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Form No. 1
APPLICATION FORM FOR ISSUANCE OF RESIDENT CERTIFICATE
1. Personal Details:
Name of Applicant _____________________________________________________ Paste
Gender _________________ Marital Status ________________ Applicant’s
Photo
Age _________________ Religion ________________ (Passport size)
Father’s Name _____________________________________________________
Husband’s Name _____________________________________________________
Mobile No. ___________________ Aadhaar No. ________________
e-Mail ID _____________________________________________________
2. Permanent Address:
Village/ Town: __________________ Police Station: ________________ Post Office: _______________
Tahasil: _______________________ District: ______________________ Pin: ______________________
State: _________________________
3. Present Address:
Village/ Town: __________________ Police Station: ________________
State: _________________________
4. Submitter’s Details:
Submitter's Name (in case the submitter is not the applicant) :________________________________
Relation with applicant:__________________________________________
5. Purpose: _________________________________________
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6. Since when the applicant has been residing in the above locality :- ____________
(mention the month & year)
7. List of Documents attached: [see note (a) of rule 3]
i) Copy of RoR
Mouza (Revenue ______________ KhataNo ____________________

Village ) .
Recorded Tenant (Land _____________________________________________________

Owner)
Relation of the applicant with Recorded Tenant ___________________________________________
ii)Voter ID / Aadhaar Card / PAN card / Passport / etc.
iii) Electricity Bill / Telephone Bill / Land agreement with house owner / Bank Passbook /
Driving Licence / Educational certificates, etc.
8. Declaration:
I, Shri/Miss/Mrs_____________________________ Son of / Daughter of / Wife

of___________________________ age _________________ of _____________________ (detailed
address) ____________________________ PS ___________________________ District
____________________ Odisha, do hereby declare that the information given by me in this application
form and its self-attested enclosures is true to the best of my knowledge and that the information
furnished is exhaustive and I have not suppressed any fact. That, I am solely responsible for the
accuracy of the declaration and information furnished and liable for action under section 199 and 200 of
the Indian Penal Code in case of wrong declaration and information. Also, I am well aware of the fact
that the certificate shall be summarily cancelled and all the benefits availed by me shall be summarily
withdrawn in case of wrong declaration and information.
Place:
Signature of the Applicant /
Date:
Authorised representative
Strike out which is not applicable
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Form No. 2
[See Rule 4 (1)]
APPLICATION FORM FOR ISSUANCE OF LEGAL HEIR CERTIFICATE
1. Personal Details
Name of
Applicant ______________________________________________________
Gender _______________ Marital Status __________________ Paste
Applicant’s
Age _______________ Religion __________________ Photo
(Passport size)
Father’s Name _______________________________________________________
Husband’s Name _______________________________________________________
Mobile No. _______________ Aadhaar No. ______________________
e-Mail ID _______________________________________________________
2. Permanent Address
State: _________________________
3. Present Address
State: _________________________
4. Submitter’s Details
Submitter's Name (in case the submitter is not the applicant):______________________________
Relation With Applicant:__________________________________________
5. Purpose: _________________________________________
6. Deceased Information:
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Name of the Deceased person: _____________________________________________________
Age:_______ Gender:_________ Place of Death:_______________Date of death: _________

(on the date of
death)
7. Legal heir details:
Sl. Marital
No. Name Age Status Relationship with deceased
8. List of Documents attached
i) Voter ID / Aadhaar Card
ii) Copy of death certificate

iii)Copy of first page of Service Book if deceased was a Govt. employee
iv) Copy of finally published settlement RoR / consolidation RoR
9. Declaration:
I, Shri/Miss/Mrs_____________________________Son of / Daughter of / Wife of

___________________________ age_________________ of _____________________
(detailed address)_______________________PS___________________________
District ________________Odisha, do hereby declare that the information given by me in this
application form and its self-attested enclosures is true to the best of my knowledge and that
the information furnished is exhaustive and I have not suppressed any fact. That, I am solely
responsible for the accuracy of the declaration and information furnished and liable for action
under section 199 and 200 of the Indian Penal Code in case of wrong declaration and
information. Also, I am well aware of the fact that the certificate shall be summarily cancelled
and all the benefits availed by me shall be summarily withdrawn in case of wrong declaration
and information.
Place:
Date: Signature of the Applicant /
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Form No. 3
APPLICATION FORM FOR ISSUANCE OF INCOME CERTIFICATE
1. Personal Details
Name of _____________________________________________________ Paste

Applicant
Applicant’s
Gender _________________ Marital Status ________________
Photo
(Passport size)
Age _________________ Religion ________________
Father’s Name _____________________________________________________
Husband’s Name _____________________________________________________
Mobile No. ___________________ Aadhaar No. _________________
e-Mail ID _____________________________________________________
State: _________________________
3. Present Address
State: _________________________
Submitter's Name (in case the submitter is not the applicant):______________________________
5. Purpose: _________________________________________
6. Annual Income Details [ see note (c) of rule 3]
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Sl. No. Source Income (in Rs)
1. Agricultural land
2. Salary
3. Other sources
7. Total Income (in Rs): ___________________________________

8. List of Documents attached:
i) RoR copy
ii) Voter ID / Aadhaar card
iii)Copy of salary certificate, if any
9.Declaration:
I, Shri/Miss/Mrs___________________________________Son of /Daughter of/ wife of
___________________________ age _________________ of _____________________ (detailed

____________________ Odisha, do hereby declare that the information given by me in this
and information.
Place:
Signature of the
Applicant /
Date:
Authorised
representative
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Form No. 4
APPLICATION FORM FOR ISSUANCE OF SOLVENCY CERTIFICATE
1. Personal Details
Paste
Name of
Applicant _____________________________________________________ Applicant’s
Marital Photo
Gender _________________ Status __________________
(Passport size)
Age _________________ Religion __________________
Father’s Name _____________________________________________________
Husband’s Name _____________________________________________________
Mobile No. ___________________ Aadhaar No. ____________________
e-Mail ID _______________________________________________________
State: _________________________
3. Present Address
State: _________________________
Submitter's Name (in case the submitter is not the applicant) :______________________________
5. Purpose: _________________________________________
6. List of Immovable Properties Approximate value (in Rs.)
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(i) Land
(ii) Buildings
(iii) Any other immovable properties (to be specified)
7. Solvency Certificate for amount (in Rs.): _________________
8. List of Documents attached:
i) Voter ID / Aadhaar Card

ii) Copy of RoR
iii) List of immovable properties
iv) Copy of Encumbrance Certificate
9. Declaration:
I, Shri/Miss/Mrs______________________________________ Son of / Daughter of

/ wife of
___________________________ age _________________ of _____________________ (detailed

and information.
Place:
Date: Signature of the Applicant /
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Form - 5
APPLICATION FORM FOR ISSUANCE OF GUARDIANSHIP CERTIFICATE
1. Personal Details
Name of
Applicant _____________________________________________________ Paste
Gender _________________ Marital Status ________________ Applicant’s
Photo
Age _________________ Religion ________________ (Passport size)
Father’s Name _____________________________________________________
Mother’s Name _____________________________________________________
Mobile No. ___________________ Aaadhar No. ___________________
e-Mail ID ______________________________________________________
State: _________________________
3. Present Address
State: _________________________
Submitter's Name (in case the submitter is not the applicant) :_______________________________
5. Purpose: _________________________________________
6. Legal Guardian:
Name: ____________________________________________
Father’s Name: ____________________________________________
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Police Station: _________________ Tahasil: ___________________
Relation with the minor/person incapable of managing his/her own

affairs
7. List of Documents
i) Birth Certificate (If minor)
ii) Certificate in support of physically / mentally challenged (if applicable)
iii) Legal Heir Certificate
iv) Voter ID / Aadhaar card
v) Documentary evidence in support of receipt of pension, family pension, retirement/death

gratuity, etc. of the deceased
8. Declaration:
I, Shri/Miss/Mrs___________________________________Son of/Daughter of/ Wife of
___________________________ age _________________ of _____________________ (detailed

and information.
Signature of the Applicant / Authorised representative
Place:
Date:
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Office of the Tahasildar ………………………………..
Miscellaneous Certificate Case No..……………………of 20………
RESIDENT CERTIFICATE
This is to certify that Shri/Smt./Miss ………………………………….. son/daughter/wife of

Shri …………………………………………is a native of the district of …………………….. in the
State of Odisha / in the State of *…………………… (mention the name of the State in case he
originally belongs to other State) and he/his family ordinarily has been residing in
Village/Town …………………………….........P.S……………..……….. Tahasil………………… in
the District of ……………………. in the State of Odisha since ………………….. (mention the
month and the year).
2.This certificate is being granted only for the purpose of ………………………………………
Signature of the Revenue Officer
Date ….……………………..
Designation (with seal of office)
Signature of the applicant
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LEGAL HEIR CERTIFICATE
This is to certify that the person/persons specified below is/are the legal heir/heirs of
late Shri/Smt./Miss ………………………. son/daughter/wife of Shri…………………………..
ofVillage/Town…………………… P.S………………… Tahasil …………………..in the District
of………………….. in the State of Odisha.
2. This certificate is being granted only for the purpose of …………………………………….
Name Age Marital Status Relationship with the

Deceased
1.
2.
3.
Signature of the applicant (s)
Date ….……………………..
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INCOME CERTIFICATE
This is to certify that Shri/ Smt./ Miss………………………….. son/ daughter/wife of
Shri………………… of Village/Town ………………P.S………………………..
Tahasil………………… in the District of ……………….., in the State of Odisha has an
Annual income of Rs ……………..(Rupees ……………………………………………..) only
from the sources specified below.
Source Annual income (Rs)
Agricultural land
Salaries
Any other source (s) (to be specified)
2. This certificate is being granted only for the purpose of ………………………….
Date ………………………..
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SOLVENCY CERTIFICATE
This is to certify that Shri/ Smt./ Miss ..................................….........son/daughter / wife
of Shri....................................................................................... of Village/Town
…………………..P.S........................ Tahasil …………………......in theDistrict
of.......................................... in the State of Odisha is solvent to the extent of
Rs………………. (Rupees …………………………….) only.
Immovable Properties Approximate value (in Rs.)
(i) Land
(ii) Buildings
(iii)Any other immovable properties (to be specified)

Date………….………………
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Office of the Collector………………………………..
GUARDIANSHIP CERTIFICATE
This is to certify that Sri/Smt./Miss …………………………………………………son/
daughter / wife of .......................................................………………………….........of
Village/Town………………………..P.S.………………….………………….……Tahasil......………
in the District of ……………………is the legal guardian of
Sri/Smt./Miss……………………………………… aged……… years, son/daughter/wife of
……………………………………………………………………………….…..……………………….of
Village/Town………………………………….……..P.S……………………………………….Tahasil
……………………in the District………………………….. in the State of Odisha who is a
minor/person incapable of managing his/her own affairs.
2. This certificate is being granted only for the purpose of ………………………
Date………….………………
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PROCLAMATION
It is hereby informed to the general public that Shri/Smt./Miss………………
……………………………………………………..son / daughter / wife / father / brother
of……………………………………….of Village/Town………. ……………………………
P.S……………..……….. Tahasil………………… in the District of …………………….........has
applied for issue of legal heir certificate of Late……………………………………. who died on
As enquired by the RI………………….., the following persons are found to be legal
heir (s) of Late…………………………………………………………………………..
1.
2.
3.
Anybody having any objection to the list of legal heirs may file objection within a
period of fifteen days from the date of this publication.
No objection shall be entertained after expiry of the schedule period
Date ..........................
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Application Form For Mutation
I. Applicant Details(please fill in the block letters)
II. Name of Father/Husband/Representative:
Present Address:
PIN
Caste
Mobile No
Email ID
Permanent Address:
PIN
III. Schedule of Property
Distict : Tahasil : RI Circle:
Police Station: Village: Thana No:
Khata Plot Kisam Total Transacted Name of Name of

No. No. Area area Recorded Vendor(in
Tenant case of
sale
purchase)
Name and address of tenant as per RoR:
Village
Caste
Types of Mutation: Sale Purchase/Inheritance/Partition/Court Decree/Any other(Please

specify)
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IV. Documents Relied(All documents between recorded tenant and present purchaser)
Name of Document Name of Name of Name of

documents No:/Year Vendor(if Vendee(if SR/DSR
applicable) applicable) Office
Case No./Year Name of Court Date of Order
I…………………………………………………………………..,S/o,D/o,W/o……………………………
………………hereby declare that the information provided by me in the application is true to the
best of my knowledge and belief.
Place: Signature of the Applicant/
Date: Authorised representative
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Register of Mutations Reported to the Tahasildar
1 Serial No
2 Date of submission of the report to the Tahasildar
3 Particulars of changes requiring corrections of the

record-of-rights.
4 Remarks
Court Fee Register
1. Serial No. of document
2. Process Fees
3. Other Fees
4. Date
Daily Total
1. Process Fees
2. Other Fees
3. Total
4. Remarks
Instructions -This register is meant to show in detail every document filed bearing court-fee stamps
except certified copies, the stamps on which are to be entered in this register by the Court or Office
which issues them. At the time the stamps are first punched a serial number should be entered on the
stamp as well as in every document (including certified copies at the time of issue) immediately
below the stamps and in column 1 of the register, in the remaining columns of which will be entered
the amount of the fees realised on the document. The entries in columns 2 and 3 will be totalled daily
and the results entered in columns 5, 6 and 7 and initialled daily by the Presiding Officer. The entries
in the latter three columns should also be totalled monthly.
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Mutation Register
1. Serial Number
2. Name of petitioner or nature of document occasioning

the Case
3. Abstract of the case
4. Date of institution
5. Date of order No
6. Abstract of orders
7. Remark
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Form of General Notice
General Notice Inviting Objection in Mutation Case
(Individual Notice inviting objection in mutation case)
In the Court of Tahasildar ……………………..Mutation Case No………................... of Yr.………….
It is hereby notified for general information that the aforesaid mutation case instituted
by…………………………………………………. for correction of Khata/ Khewat No………………….of
Village…………........ Thana………………..Tahasil…………. District………………………….. Thana
No…………………. has been posted for hearing on ……………..Any person having any objection to
the proposed change of the record as mentioned below may file an objection petition before the
undersigned on or before ...........................which will be duly considered before the disposal of the
mutation case. No objection petition will be entertained after the aforesaid date.
Tahasildar
Changes proposed to be made
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Form of Individual Notice
(Individual Notice inviting objection in mutation case)
In the Court of the Tahasildar....................................………………………….Mutation Case

No………………………............Village…………………..........
Take notice that the aforesaid mutation case instituted for correction of Khata/Khewat
No…………………..Village……………….Thana…………………Tahasil…………….District
………………..Thana No………………..has been posted for hearing
on..........................................……………………..
If you have any objection to the proposed change of the record as mentioned below you may file
an objection petition before undersigned on or before........................................which will be duly
considered before the disposal of the mutation case. No objection petition will be entertained after the
aforesaid date.
Tahasildar
Changes proposed to be made
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Register of process made over to the Nazir for service
1. Serial number
2. Number and date of cases to which process relates
3. Character of process
4. Date of issue
5. Date when returnable
6. Reciever’s intials with date
7. Date of return
8. Remark
Notes I. This register; being intended as a check on the Nazir's Department must not be
left in the hands of Nizarat establishment.
2. In the Certificate Department, orders issued to the Nizarat for execution in
connection with certificates filed should be noted in this register.
Mutation case objection petition Register
1. Serial Number
2. Name and address of the objector
3. Serial Number of the mutation case in the mutation
register to which the objection relate
4. Abstraction of objection
5. Date of disposal of the mutation case
6. Purpose of the order on the objection petition
7. Remarks
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Register of Attendance of witnesses in the Revenue Court
1. Serial number on the witness

2. Name of the witness
3. Number of case in the register for cases of this class
Date of Attendance
4. First Day
5. Second Day
6. Third Day
7. Fourth Day
8. Fifth Day
9. Sixth Day
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Register of Measurement and Mutation fees
1 Serial No.
2 Serial No. of the mutation case in which the fees is released
3 Name of depositor
4 Amount of-
(a) Measurment or inspection Fees
(b)Mutation Fees
5 Serial No. of the relevant entry in the register of miscellaneous receipt
in the Tahasil Office.
6 Number and date of the challan under which the amount is credited
into the Treasury.
7 Name of the Naib-Tahasildar who conducted the measurement or

inspection.
8 Remuneration payable to the Naib-Tahasildar under paragraph 114 of

the Manual
9 If the fee realised is more than what is realisable then the amount
refundable to the party.
10 Number and date of Treasury Voucher in which the amount is drawn

for payment under Column 8.
11 In case of refund of column 9, date of presentation of the refund bill in

the Treasury.
12 Remarks.
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Amin's Enquiry Report Form
1. Case No.
2. Date on which the order for enquiry was received.
3. Date on which the enquiry was conducted.
4. Report of enquiry (this should be brief but completely
giving all necessary information and details of
enclosures
if any).
Date, Signature and designation of

the person submitting the report
Intimation Slip
Office of the Tahasildar……………………….

District ……………….
Case No……………… of ……………………
The following changes in the record-of-rights have been ordered.
Name of Village ………………....................
Name of Thana ……………………
Thana No……………………
*Details of change ………………………
Tahasildar
*In case the change involves sub-division of plots, a sketch map indicating the sub-division shall be
enclosed in the slip which is meant for the Naib-Tahasildar.
Certified that the changes mentioned in the slip have been incorporated in all the relevant registers on
...............
Naib-Tahasildar
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Register of Changes-A
Register showing changes affecting Demand of …………........... Village for……………

1. Serial No.
2. Holding No.
Changes in Assessment
3. Rent
4. Water-tax
5. Cesses
6. Nistar cess
7. Total
8. Date from which the order is effective
9. No. and date of order sanctioning change and brief
description of the change.
10. By whom given up or to whom transferred or assigned
or other particulars.
11. Remarks
NOTESAll changes resulting in addition to the demand shall be written in black ink and those
involving decrease in the demand in red ink and the net result worked out at the end of Fasli year.
Register of Changes-B
Register showing changes not affecting demand of.……………Village for the ………………
1. Serial No.
From whom transferred
2. Holding No.
3. Name of the Holder
To whom transferred
4. Holding No.
5. Name of the Holder
Assessment
6. Rent
7. Water-tax
8. Cesses
9. Nistar cess
10. Total
11. Date from which the order is effective
12. No. and date of the sanctioning the change and brief
description of the change
13. Remarks
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Register of Appeals in Mutation Cases
1. Serial number
2. Name of parties
3. Name of office or officers against whose
decision the appeal is made
4. Date of decision of lower Court.
5. Date of institution of appeal
6. Date of order in appeal and by what
officer passed
7. Purport of order
8. Remarks.
Return to be submitted by the Tahasildar
1. Name of Tahasil
2. No. of mutation applications pending at

the close of the last month
3. No. of mutation applications received
during the month
4. Total pending for disposal
5. No. of mutation applications disposed of
during the month
6. No. of cases pending for disposal at the
close of the month
7. No. of cases pending for more than three
months
8. No. of disposed of cases in which the
record-of-rights has not been corrected
9. Remarks.
32 | P a g e
Odisha Special Survey and Settlement
FORM OF PROCLAMATION
All the Land owners / persons having interest in the land including the custodian of
Government land of Revenue Village:- .................................... Thana No.:- ....................................Tahasil:-
.................................... District:- .................................... are hereby informed that the undersigned or any
person authorized or deputed by the undersigned may enter upon your land to identify and
demarcate the village boundary as well as its parcels of land. You are directed to co-operate with
them in examining/measuring the land as well as cutting down or removing trees, fences, standing
crops or other such obstructions, as may be necessary for the purpose of survey and not to put any
hurdle/hindrance in discharge of their duties.
You are further directed to demarcate the boundaries of your land/parcels of land by erecting
pillars/ mounds of earth at all bends and corners of their boundary.
Date .................................... Tahasildar ....................................
33 | P a g e
FORM FOR SELF DECLARATION OF LANDS OWNED/HELD BY LAND OWNERS
Revenue Village:- .......................... Thana No.:- ........................Tahasil:- .................... Police Station:-

..................... District:- ........................
Name of the Details of lands owned/held

land Basis of claim
owner over the land
(including such as
Permanent Area Classifica Jamabandi Remark
name of co- Khata Plot Bound Rent/ succession/gif
address A. tion of No. if any
sharers No. No. ary Cess. t purchase/
according to D. Land settlement/
share, if any) & others
Father's name
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)
I/We declare that the entries made in self-declaration are true to my/our knowledge. In case
of any wrong entry in self-declaration, I/We shall be held liable for the same.
Note :This form shall be submitted in duplicate. One copy shall be made over to the petitioner
in token of receipt after initiating and putting date and serial no. of the petition by the receiving
officer/employee.
Place:- Date:-
Signature/Thumb impression of the land owner.
34 | P a g e
FORM FOR VERIFICATION CERTIFICATE ISSUED AGAINST SELF-DECLARATION.
(For Official use only)
Revenue Village:- ThanaNo.:- Tahasil:- District:-
Serial No. Entries of land

Details of land
of self- found correct
Name
declaration
of the Classification Jamabandi Rent/ Remarks,
submitted Area
land of Land No. Cess. Khata Plot Area if any.
by the Khata Plot A. Boundary A.
owner No. No. No. No.
land D. D.
owner
(1) (2) (3) (4) (5) (6) (7) (8)
Signature of Signature of Signature of
Record Keeper Revenue Inspector Tahasildar
35 | P a g e
FORM FOR REGISTER OF UN-VERIFIED/DISPUTED LANDS.
(For Official use only)
Revenue Village:- ................................... Thana No.:- ....................................Tahasil:- ....................................

District:- ..................................
Serial No. of
Name self- Brief
Jamabandi
of the declaration Classification reasons for
Details of land No. Remarks
land submitted by of Land non
(if any)
Owner the land verification
owner
Khata Plot Area

Boundary
No. No. A D.
(1) (2) (3) (4) (5) (6) (7)

Record Keeper Revenue Inspector Tahasildar.
36 | P a g e
ABSTRACT OF RECORD OF RIGHTS
Revenue village:- ..................................... Thana No.:- .....................................Tahasil:-

..................................... District- ..................................
Name of the land Area

Serial No.
SI. owner father's/ Plot Rent/
of record Remarks
No. husband's name & No. Cultivated Uncultivated Others Total Cess
of rights
address
(1) (2) (3) (4) (5) (6) (7)

Amin Revenue Inspector Tahasildar
37 | P a g e
FORM OF PLOT REGISTER
Village:- .................................. Thana No.:- ..................................Tahasil:- .................................. District:-

..................................
Name of
the land
Plo owner,
t father's/ Khata Area Bound Classificati Rent/
Area Under Crop Remarks
No husband' No. A. D. ary on of Land Cess
. s name,
caste,
address
Othe
Kh Rabb Cultivabl
r Uncultivable
arif i e
crop
(1) (2) (3) (4) (5) (6) (7) (8) (9)

Amin/ Licensed Survey/Revenue Inspector Tahasildar.
38 | P a g e
FORM OF PRELIMINARY RECORD OF RIGHTS
Revenue Village:- .................................. Thana No.:- ..................................Tahasil:-..................................

District-..................................
Name of the land Khata

Plot No.
owner/ Land No.
lord, Are
Basis for entry in the
father's/husband a Rent
Boundar Classificatio revenue records like Remark
's name, caste & /
y n of Lands succession/gift/purchas s
address (In case Ol Ne Ol Ne A. Cess
d w d w e/ exchange/ others
more than one D.
land owner their
names & share)
(1) (2) (3) (4) (5) (6) (7) (8) (9)
Seal and Signature

of Tahasildar.
39 | P a g e
FORM OF CLAIMS/OBJECTIONS AND FORM OF ACKNOWLEDGEMENT OF
CLAIMS/OBJECTIONS.
1. Name, Father's/Husband's name and full address of the claimant/objector:-
2. Name, Father's/Husband's name and full address of the opposite party:-
3. Details of disputed lands:-
Revenue Village:- ....................... Thana No.:- ......................Khata:- ........................ Plot-

....................... Area:- ..........................
4. Gist of claim/objection:-
5. Relief sought:-
Signature/Thumb impression of the

claimant/ objector ..........................
---------------------------------------------------------------------------------------------------------------------------------------
----------------------------------
FORM 9
[See Rule9(8)]
Sl. No. .................................. Date .................................. Name of the claimant/objector

....................................................................
Signature of the Receiving

Officer/ Employee.
Note:-Portion below the line shall be torn and made over to the claimant/objector as token of receipt
of the claim/objection petition.
40 | P a g e
FORM OF REGISTER OF CLAIMS/OBJECTIONS.
Revenue Village:- .................................. Thana No.:- ..................................Tahasil:- ..................................
District- ..................................
Name of Disputed land

Date of the Date of
Name of the Substance
Sl. filing opposite Area Date of correction
claimant/objector of orders
No. of the party with Khata Plot A. disposal according to
with full address No. No. with date
petition full D. orders
address
(1) (2) (3) (4) (5) (6) (7) (8)
41 | P a g e
FORM OF NOTICE
Shri/Smt ....................................................... Son/ Daughter/ Wife of Shri ................................................

resident of village ............................... Post Office ..................................Thana ..................................Tahasil
.................................. District .................................. is hereby informed that hearing with respect to
claims/objections filed on .................................. (date), the details of which are given below, has been
fixed on date .................................. A.M./P.M. at .................................. (Place).
Details of claim/objection
Details of land
Case Name of the claimant/
Gist of
No. and objector along with,
Name of Area claims/
date of father's/ husband's name Thana Khata Plot
revenue A. Boundaries objections
filing & address No. No. No..
village D.
(1) (2) (3) (4)
You are directed to appear personally or through your authorized agent on the date, time and
place fixed with evidence, if any, in support of your claim/objection.
If you do not appear of the date, time and place fixed for hearing, the case may be disposed off
ex parte on the basis of available records.
Seal and Signature of Tahasildar.
42 | P a g e
FORM OF DRAFT RECORD OF RIGHTS
Revenue Village:- ........................... Thana No.:- ..........................P.S ............................Tahasil:-

............................ District ............................
All land owners/ persons having interest in any land of revenue village ..................................
Thana No.................................., the details of which are given below, are informed that the draft record
of rights with respect to land of Revenue Village .................................. Thana No .................................. is
hereby published:
Sl. No. Khata Name of Plot Area Boundary Classification Cultivable area Un culti- Rent/ Remarks
of the No. the land No. A. of Lands under crop vable Cess
khatian owner, D.
father's/
husband's
name,
caste and
residence
Kharif Rabbi others
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)
The draft record of rights shali remain published till .................................. (date),You are
requested to peruse the draft record of rights with regard to your land or in land on which you have
any subsisting interest.
Seal and Signature of Tahasildar
43 | P a g e
FORM OF NOTICE INVITING CLAIMS/OBJECTIONS DURING PUBLICATION OF THE
DRAFT RECORD OF RIGHTS.
Notice to:-All concerned persons of Revenue Village:- .............................. Thana No.:-

...............................Tahasil:- .............................. District:- ..............................
It is hereby informed that the draft record of rights including map of Revenue Village
..................................Thana No. .................................. Tahasil .................................. District
.................................. has been prepared and is being published from .................................. to
.................................. During this period, it shall remain available to all land owners and concerned
persons for inspection, free of cost. During the aforesaid period, claim/objection petition with respect
to entry in and omission from the draft record of rights may be filed and the same shall be received in
the Tahasil Office.
Place:-
Date:-
44 | P a g e
FORM OF FILING CLAIMS/OBJECTION
1. Name, father's/husband's name and full address of the claimant/objector:-
2. Name, father's/husband's name and full address of the opposite party: -
Revenue Village:- ............................ Thana No.:- ............................Khata:- ........................ Plot:-

........................ Area:- ........................
5. Relief sought:-
Signature/Thumb impression of the

claimant/objector ...........................
---------------------------------------------------------------------------------------------------------------------------------------
---------------------------------
FORM OF ACKNOWLEDGEMENT OF CLAIMS/OBJECTIONS.
Sl.No. .......................Date .............................. Name of the claimant/objector

......................................................................................
Signature of the Receiving

Officer/Employee.
Note: - Portion below the line shall be torn and made over to the claimant/objector as token of receipt
of the Claim/objection petition.
45 | P a g e
FORM OF REGISTER OF CLAIMS/OBJECTIONS FILED DURING DRAFT PUBLICATION OF
RECORD OF RIGHTS.
Cas Name of Date of

e Name of the respond correcti
No. claimant/objec ent Date Gist on
Sl.
and tor, father's/ of of accordi Initial of
N Details of disputed land
dat father's/husba husband' heari the ng to the officer
o.
e of nd's name and s name ng order order, if
filin full address and full require
g address d
Pl
Reven Tha Khat
Taha ot
ue na a Area
sil No
village No. No.
.
(1) (2) (3) (4) (5) (6) (7) (8) (9)
46 | P a g e
FORM OF NOTICE TO PARTIES FOR HEARING OF CLAIMS/OBJECTIONS FILED
DURING DRAFT PUBLICATION OF RECORD OF RIGHTS.
Shri/Smt.................................................................... Son/Daughter/Wife of Shri

.................................................................... Resident of Village .................................. Post Office
..................................Thana ..................................Tahasil .................................. District ..................................
is hereby informed that hearing with regard to claims/objection filed on .................................. (date),
the details of which are given below, has been fixed on .................................. A.M./P.M
.................................. at .................................. (place).
Details of land
Case Date of Parties Gist of claims/
No. filing involved Revenue Area objection
Thana No. Khata No. Plot No. Boundaries
Village A. D.
(1) (2) (3) (4) (5)
place fixed for hearing along with evidences in support of your claim/objection, failing which, the
case may be disposed of ex parte on the basis of the available records.
Seal and Signature of Tahasildar
47 | P a g e
FORM OF ABSTRACT OF NEW RECORD OF RIGHTS
Revenue Village:- .................................. Thana No ..................................Tahasil:- ..................................

District:- ..................................
Name of Area
Old New Name of New
Sl. new Rent/
Khata Khata old land Plot Remarks
No. land Cess
No. No. owner No. Cultivatable Uncultivatable Others Total
owner
(1) (2) (3) (4) (5) (6) (7) (8) (9)
Seal and Signature of Tahasildar.
48 | P a g e
FORM OF NEW PLOT REGISTER
Revenue Village- ..................................Thana No. - .................................. Tahasil- ..................................

District - ..................................
Old New Name Name Area under Crop

Old New Old New
Sl. Area Area Old New of old of new Rent/
Plot Plot Khata Khata Other Culti- Un- Remarks
No. boundary boundary land land Cess
No. No. No. No. Kharif Rabbi
A. D. A. D. owner owner crops vable cultivable
(1) (2) (3) W (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)
Signature of Amin/ Signature of

Licensed Surveyor Revenue Inspector
49 | P a g e
FORM FOR FINAL PUBLICATION OF RECORD OF RIGHTS
All the land owners /persons having interest in any land of revenue village
.................................. Thana No .................................. are hereby informed that final record of rights in
respect of the land of the Revenue Village .................................. Thana No .................................. the
description of which are given below, is being published.
Revenue Village:- ........................... Thana No.:- ............................ P.S. ............................Tahasil:-

........................... District. ...........................
Sl. Are Cultivable area

Name
No. under crop
of the Plo a Rent
of the Khat Boundar Classificatio Uncultivabl Remark
land t /
recor a No. y n of Land e s
owner No. B. Khari Rabb Other Cess
d of
s D. f i s
rights
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)
The final record of rights shall remain published till .................................. (date). You are
requested to peruse the final record of rights during this period.
Date: Seal and Signature of the

Collector of the District
50 | P a g e
FORM FOR FILING CLAIMS/ OBJECTIONS AFTER THE
FINAL PUBLICATION OF RECORD OF RIGHTS.
1. Name, father's/husband's name and full address of the claimant/objector:-
2. Name, father's/husband's name and full address of the opposite party:-
Revenue Village:- ........................... Thana No.:- .......................Khata:- ....................... Plot-

......................... Area:- ............................
5. Relief sought: -
Date:-Signature/Thumb impression of the claimant/objector
51 | P a g e
FORM OF NOTICE TO PARTIES FOR HEARING OF CLAIMS/OBJECTIONS
FILED AFTER FINAL PUBLICATION OF RECORD OF RIGHTS
Sri/Smt .................................................................... Son/ Daughter/ Wife of Sri

.................................................................... Resident of Village .................................. Post Office
..................................Thana ..................................Tahasil..................................District .................................. is
hereby informed that hearing with regard to claim/objection filed on .................................. (date). the
details of which are given below, has been fixed on .................................. at
..................................A.M./P.M .................................. (place).
Details of Land
Case Date of Parties Khata Gist of claim/
No. filing involved Revenue Thana Plot Area objection
No. Boundaries
village No. No. A. D.
(1) (2) (3) (4) (5)
place fixed for hearing along with evidence in support of your claim/objection, failing which the case
may be disposed of ex parte on the basis of available records.
Seal and Signature of the

Additional District Magistrate
52 | P a g e
OGLS ( Odisha Government Land Settlement )
APPLICATION FOR SETTLEMENT OF LAND
To
The Tahasildar…………………….
1. (a) Name of the applicant

(b) Age
2. Father's name
3. (a) Present residential address
(b) Permanent home address
4. Caste, whether S.C./S. T./Others.

5. Number of family members
6. Whether belongs to joint family or a member of single family.
7. Annual income
(a) From Agricu1ture
(b) From other sources ,
8. Extent ot land owned by him in his name or in the name of other members of
his family in Urban Area/ Rural Area
9. (a) Occupation of the applicant
(b) Occupation of the family Members
10. Detailed particulars of land applied for:

(a) Name of villlage/Name of urban area
(b) Holding number , If any
(c) Plot number, if any
(d) Area applied for
(e) Boundary
11. Purpose for which the land is required

Dated:
Signature of the Applicant
53 | P a g e
Form of Register
1. Serial number
2. Date of application
3. Whether for agriculture, homestead or any other purpose.
4. Name and residence of applicant
5. Name of village/Urban area, Khata No. Plot No. of the land applied for
6. Area of the plot with its boundaries as given in the application.
7. Area of the plot as ascertained by actual enquiry.
8. Amount of survey fees paid .
9. Date of payment. .
10. Value of forest growth paid
11. Date of payment
12. Date of completion of survey
13. Abstract of final order with date amount of premium fixed.
14. Amount of premium paid, if any .
15. Date of payment
16. Date of settlement area settled
17. Date of issue of Patta/ execution of agreement, as the case may be,
18. Remarks-
[Here mention the category under which the applicant falls with reference
to sub-section [3] of Section 3 and sub-rule [3] of Rule 3 of the Rules)
54 | P a g e
PROCLAMATION OFFICE OF TAHASILDAR
It is hereby informed to the General Public that Shri…………………………………… son of

…………………………………..Village ………………………..P.O……………………, District
………………………...has applied for lease of Government land mentioned in the Schedule below.
Anybody having any objection to such settlement may file objection petition within a period of thirty
days from the date of publication of this proclamation affixing Court Fee of Rs.1.30 (Rupees one and
thirty paise) only to the undersigned. No objection petition will be entertained after expiry on the
schedule period.
SCHEDULE
Village…………………. Khata No:…………….. Plot No. …………Area . …………
TAHASILDAR
55 | P a g e
INTIMATION SLIP FOR SETTLEMENT OF LANDS
1. Office of the Tahasildar

2. District
3. Case No.
4. Name of Village
5. Name of Thana
6. Thana No. of the village
7. Name of the person in whose favour land is ordered for settlement.
8. Plot No. and Area in acres
9. Annual rent and cess ,
10. Purpose of settlement
11. Remark.
12. Certified that the above particulars have been incorporated in the relevant register .
TAHASILDAR
56 | P a g e
SCHEDULE I
AFFIDAVIT
In the Court of Shri………………………………

Magistrate………………………………………..
I,Shri.………………………… aged ………son of………………….…………..village

……………………….. P.O………………………. P.S………………….. in the district of
………………………..at present ………..by profession do hereby solemnly affirm as follows-
1. That my Income from all sources is Rs ……………… (Rupees ….............................................).

2. That I or any of my family members do not own or posses any residential house / building or
homestead land in the jurisdiction of ………………town ………...
3. That I own or possess a residential house/ building or homestead in the jurisdiction of town but
this has inadequate accommodation, the extent of the homestead land being ……………. cents.
4. That my family consists of besidesmyself .

(i) Husband
(ii) Wife
(iii) Sons
(iv) Unmarried daughters.
(v) Widowed and dependant daughters.
(vi) Brothers below …….years and unmarried sisters.
(vii) Father
(viii) Mother,
(ix) Step Children.
5. That my continued stay in this town is necessary in the interest of my employment business trade
profession and avocation,
6. That I have not been considered for any homestead plot in the town earlier and that my application
has been rejected.
7. That I solemnly swear and affirm that the above statement are true to my knowledge, and I. swear
that I have concealed anything regarding existing property, owned either by me or by any of my
family members mentioned above.
Identified by me Signature of the deponent
57 | P a g e
ADVOCATE
Shri ………………………………..aged …………………..years, son of ……….

……………………………..resident of village……………………… P.O…………….. P.S
……………………….in the District of …………………… at present by profession who is identified by
Shri …………………………. Advocate, appears before me and states on oath that the contents of this
affidavit are true to the best of his knowledge.
Deponent Magistrate
(Strike out whatever is unnecessary)
58 | P a g e
POWER TO SANCTION SETTLEME'NT OF GOVERNMENT LAND
Sl.No. In whose favour Officer exercising In rural area In urban area

powers excluding
Bhubaneswar,
Rourkela, Sunabeda
1. In favour of Not exceeding one
Collector Nil
Educational acre
Charitable, Religious Not exceeding one
R.D.C Exceeding one acre acre
,Cultural
Philanthropic, but not exceeding
Literary, Social and five acres Exceeding one
Member, Board of acres but not
Financial Institutions.
Revenue Exceeding five exceeding five
acres but not acres.
exceeding ten
acres.
1A. In favour of Deptt of

Not exceeding five Not exceeding one
Government. Collector
acres. acre.
R.D.C Exceeding five Exceeding one

acres but not acre but not
exceeding ten acres exceeding five
Member, Board of acres.
Revenue Exceeding ten acres Exceeding five
but not exceeding acres but not
fifty acres. exceeding ten
acres.
2. In favour of Local Not exceeding one Not exceeding one
Collector
Authorities. acre. acre.
Statutory Bodies, and
Corporations R.D.C Exceeding one acre Exceeding one
established under but not exceeding acre but not
any law for the time five acres. exceeding five
being in force Member, Board of Exceeding five acres.
Revenue acres but not Exceeding five
exceeding ten acres but not
acres. exceeding ten
acres.
59 | P a g e
3. In favour of Small Not exceeding five Not exceeding one
and Medium Collector acres on the acre on the
Industries. Collector recommendation of recommendation
the Dist. Industries of the Dist.
Centre. Industries Centre.
R.D.C
Exceeding five Not exceeding one
acres but not acre but not
exceeding ten acres exceeding five
on the acres on the
recommendation of recommendation
the Dist. Industries of the Dist.
Centre. Industries Centre.
4. Not exceeding
In favour of Live two acres Five Not exceeding one
Stock Farms in Collector
acres with acre.
private sector. recommendation
of Director of Exceeding one acre
R.D.C Animal but not exceeding
Husbandary and five acres.
Veterinary
Services.
Nil
5. In favour of Orissa Collector Any event subject to Nil.

Cashew -nut- availability and
Development suitability.
Corporation and
Orissa Forest
Corporationfor
Cashew -nut-
plantation.
6. In favour of Orissa Collector Ditto Any extent subject
Industrial to availability and
Infrastructure suitability.
Development
Corporation for
industrial purposes.
7. In favour of Collector Nil As per plottings
individuals for made in the plan,
homestead purposes. approved under
Rule 3(1).
8. In favour of landless Tahasildar; subject to Up to one standard Nil
agricultural labourers confirmation by sub- acre or to the extent
for agricultural divisional officer. to which the land
purposes. already owned falls
short of one
60 | P a g e
standard acre (as
defined the O.L.R.
Act.1960)
9. In favour of Tahasildar, subject to Not exceeding (ten) Nil
homesteadless confirmation by Sub- decimals.
persons for divisional Officer.
homesteads
10. In favour of Tahasildar, subject to Not exceeding one Nil
Cooperative societies. confirmation by Sub- standard acre per
divisional Officer. each member of the
society.
11. In favour of ex- Ditto Up to one standard Nil
servicemen. acre.
12 . Any other person Tahasildar, subject to As per scheme Nil
not include in the confirmation of the formulated by
above categories. SubdivisionalOfficer Government from
(i) Displaced . time to time up to
persons of irrigation one standard acre
project.
(ii)Displaced person
of other project or
categories.
(iii)Any other
person
13. For salt manufacture Government Full powers

14. For Brackish Water
Pisciculture/Prawn Not exceeding ½
(i)Sub- Collector Nil
Culture hectare.
(ii)Collector Not exceeding one

hectare. Nil
(iii) Revenue
Divisional
Not exceeding two
Commissioner Nil
and half hectares
(iv)Government
Full power Full Power
15. For Coffee Plantation Government Full power Full power
16. Any other purposes
Government Full
power
61 | P a g e
SCHEDULE IV
RULES FOR ALLOTMENT OF GOVERNMENT LANDS IN THE CIV1L TOWNSHIP OF

ROURKELA NOTIFIED AREA
1. Definition:-In this schedule, unless there is anything repugnant to the subject or context;-
(a) "Additional District Magistrate" means the Revenue Officer who is appointed by State
Government as such with headquarters at Rourkela.
( b) "Authorised Local Representative" means the officer who is duly authorized by a Head
Department of the State Government or concerned Ministry of the Union Government, to file
requisition for land within the township and receive in its behalf.
(c) "Commissioner" means the Revenue Divisional Commissioner, Northern Division Sambalpur;
(d) "Committee" means the Land Allotment Committee constituted under clause 3 of this Schedule;
(e) "Director of Industries" means the officer appointed as such by the State Government;
(f) "Form" means a form appended to the Schedule;
(g) "Middle class" means families having an income exceeding Rs. 8,400 but not exceeding Rs.30,000
per annum;
(h) "Poor class" means families having an income ,not exceeding Rs. 8.400 per annum.
(i) "Registered Societies, etc." means Societies Associations, etc. registered under the Societies
Registration .Act, 1860 or under any other Act for the time being in force;
(j) "Rourkela Civil Township" means the area within the limits of the Rourkela Civil Notified Area;
(k) "Director, Town Planning, Orissa" means the officer appointed as such by State Government;
(m) "Year" means the financial year.
2. Earmarking of plots to be settled on application and through public auction:- The Regional
Improvement Trust, Rourkela shall, in consultation with the [Director, Town Planning, Orissa]
(a) divide in accordance with the Master Plan approved by Government in the Urban Development
Department different areas reserved for different purposes in the said plan into plots of suitable size;
and
(b) Earmark the plots, except those reserved for use by Government Departments for allotment on
application from private individuals, institutions, Societies of local bodies and for settlement in public
auction;
Provided that the plots to be settled on application shall not be more than two-thirds of the total
number of plots earmarked for settlement on application and public auction:
62 | P a g e
Provided further that the area of the plots to be settled on application shall be one-third of the area of
the plots earmarked for settlement in public auction;
Provided further that no family should be allotted more than one plot either on application or
through public auction.
3. Principles to be followed - In the matter of allotment of land on application the following principles
shall be observed, namely :-
(a) There shall be a Land Allotment Committee to consider and dispose of all applications for
allotment of land received from private individuals, companies, institutions, societies and local
bodies.
(b) 'The Committee shall have five members, namely:-
(i) Commissioner,
(ii) Collector, Sundergarh,
(iii) Director, Town Planning, Orissa
(iv) Director of Industries,
(v) Additional District Magistrate
(c) The Commissioner shall act as the Chairman and Additional District Magistrate shall act as the
Secretary and Convener of the Committee.
(d) Decision of the Committee shall, subject to the order of the Government in appeal, be final.
(e) Applications for allotment of land shall be taken up by the Committee which shall meet at least
once in every quarter of a year.
(t) All applications duly received in response to the notice issued under sub-clause (1) of clause 4 shall
be considered in one batch at a time and application received after the date fixed in the said notice
shall be considered in the next quarter along with other applications duly received during that
quarter.
g) In the matter of allotment the applicants shall receive priorities in the following order .
(i) Applicants who are displaced due to acquisition of land in connection with the
establishment of the Steel Plant and Township at Rourkela and have no lands in the (Rourkela
Civil Township or Rourkela Steel Township) for the purpose, applied for;
(ii) Industrialists who have set up small or medium industries in the (Rourkela Civil
Township or Rourkela Steel Township) and do not posses any land or building I n the said
township for the purpose applied to:
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(iii) Persons belonging to the poor class or middle class of Sundergarh District who have no
lands in the (Rourkela Civil Township or Rourkela Steel Township) for the purpose applied
for;
(iv) Registered societies, etc. and .permanent residents of the State who belong to the poor
class or middle class and have no lands in (Rourkela Civil Township or Rourkela Steel
Township) for the purpose applied for ;
(v) Other applicants who belong to the poor class or middle class who have no lands in
(Rourkela Civil Township or Rourkela Steel Township) for the purpose applied for;
(h) Allotment for residential purpose shall not exceed one-tenth of an acre in extent in any
individual case. For other purpose not more than one plot as delimited in the approved
Master plan shall be ordinarily allotted.
(i) Anyone allotted land on application shall be required to pay a premium as fixed from time
to time by the Collector, with the approval of the Commissioner. In addition, he shall be
required to pay annual rent at the rate of one per cent of the premium.
(j) All allotments of !and to be made on application shall be by way of lease and the lessee
shall be required to execute lease deeds in Form No. I and get them registered at his own cost.
(Provided that the Government may exempt or reduce the premium payable in any case or class of
cases for settlement of land).
4. Filing of Applications -
(1 ) In each quarters of the year the Additional District Magistrate, shall invite applications for
allotment of lands by publishing a notice in the Official Gazette, in the newspapers having wide
circulation in the locality and in the notice boards of his office, Office of the Collector, Sundergarh and
other Revenue offices in the district.
(2) Applications shall be made in the form obtainable from the Regional Improvement Trust or the
Additional District Magistrate, on payment of a sum of rupees ten or any other sum as may be
notified by Government from time to time.
(3) The notice inviting applications shall specify clearly the details required to be furnished by the
applicant, the amount of court fee to be affixed, the authority before which and the date on or before,
which the application to be filed which date shall not be less than thirty days from the date of issue of
the notice.
(4) On expiry of the last date fixed for filing of applications, all applications so received shall be
scrutinized and entered in a register arranged according to the purpose for which the land is
required, and numbered serially for each purpose.
(5) Enquiry into the applications-
The Additional District Magistrate shall enquire either himself or through any of his Subordinate
Revenue Officer into the contents of the applications and about such other matters as are relevant to
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the question of allotment of. land and draw up lists of allottees for different purposes whom he
considers most deserving and put up before the Committee constituted for the purpose within a
period of thirty days from the last date of receipt of applications.
(6) Consideration by the Committee -
( i) The Committee shall
consider the application of persons recommended by the Additional District Magistrate along
with those not recommended and after such enquiries as they may consider necessary, draw
up final lists of allottees for different purposes within a period of fifteen days from the date of
consideration.
(ii) While considering the lists under sub-clause (1) the Committee shall abide by the
principles enumerated in clause 3.
(7) Publication of the final lists of allottees -
The final list of allottees drawn up by the Committee shall, as soon as possible, be published by the
Additional District Magistrate in the notice-board of his office, of the offices of the Commissioner,
Collector, Sundergarh, Sub-divisional Officer, Panposh and Tahasildar, Panposh.
(8) Sanction of lease -
(i) After expiry of the appeal period the Additional District Magistrate, Rourkela shall issue
orders sanctioning the leases and calling upon the applicants in whose favour allotments have
been finally made to deposit the amount of premium payable, execute the lease deed in the
prescribed form by a specified date.
Provided that no sanction order shall be issued in cases regarding which appeals have been
filed till the appeals are disposed of.
(ii) Validity of the sanction order - Allotments unless altered in appeal or where appeals are
pending shall remain valid for a period of ninety days from the date of issue of the sanction
order. The Additional District Magistrate, may, however, extend the period of validity after
duly recording reasons therefore by not more than thirty days.
(iii) Failure, of the allottee to deposit the premium, due and register the lease deed after
execution, within a period of ninety days from the date of sanction of lease or in case of
extension, within period so extended under sub-clause (2 ), shall entail forfeiture of the claim
of the allot tees to the land allotted.
9. Appeal -
(1) An appeal against the order of the Committee if presented within thirty days from the date of
publication of the list of allottees under clause (7) shall lie to Government in the Revenue Department.
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(2) The petition of appeal shall bear court-fee stamps worth rupees two and paise sixty only or as may
be notified by Government from time to time and state the grounds of appeal clearly and shall be
filed before the Additional District Magistrate.
(3) On receipt of the petition of appeal, the Additional District Magistrate shall acknowledge it and
within a week of the expiry of the appeal period, forward it along with all relevant papers to the
Secretary to Government in the Revenue Department giving his comments if any.
(4) Orders of Government on the petition of appeal shall be final and ordinarily be communicated to
the Additional District Magistrate within four months from the date of receipt of the appeal petitions.
(5) On receipt of orders from Government, the Additional Magistrate shall intimate the decision of
Government to the applicant and where necessary issue orders sanctioning lease which shall be
deemed to have passed under Sub-clause (1) of clause 8 for all purposes.
10. Principles to be observed for allotment of land through public auction -
Plots earmarked for allotment through public auction shall not be disposed of otherwise without
specific orders of Government in the Revenue Department.
11. Eligibility for participating in the auction sale -
Any person who is a citizen of lndia will be eligible for participation in the auction sale.
12. Entitlement to plots -
Successful bidders in whose favour the sale is confirmed shall, subject to the decision in appeal, if
any, be entitled to the grant of the lease of the plots auctioned.
13. Annual rent payable in addition to the bid amount-
Bidders in whose favour the leases are sanctioned shall be required to pay, in addition to the bid
amount, an annual rent equivalent to one per cent of the premium realized for the plot.
14. Notice for auction sale -
(1) In each quarter of the year the Additional Distrct Magistrate, shall issue a notice starting among
other things, the date on which and the time and place at which plots available for allotment for
different purposes will be put to public auction.
(2). The date of auction to be fixed shall not be less than thirty days from the date of issue of the
notice.
(3) The notice shall be published in the notice boards of all Revenue Offices in the district of
Sundergarh, in the Official Gazette and in news papers having wide circulation in the locality.
15. Presiding Officer for the auction sale -
(1) The Collector, Sundergarh shall preside over the auction sale.
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(2) Earnest money - Every eligible person intending to participate in the auction sale shall be required
to deposit an earnest money with the Additional District Magistrate on the appointed day of auction
sale and before the auctions are started a sum calculated at the rate of five hundred rupees per
decimal of the acre of the plot for which auction is to be held.
(3) Decisions of the Presiding Officer regarding the priority of Plot , the number of plots whether
single or otherwise, etc., to be put to auction shall be final.
16. Successful bidder to furnish an undertaking:-
The successful bidder on completion of the bid shall forthwith deposit with the Additional District
Magistrate twenty-five per cent of the bid knocked down in his favour and furnish an undertaking on
plain paper to the effect that he shall deposit the balance amount within thirty days from the date of
issue of orders sanctioning lease and calling upon him to pay the amount, unless allowed extension of
the period on application by the Additional District Magistrate and immediately thereafter execute a
lease deed In Form No. 2 get it registered at his own cost or in default, to forfeit his claim to the plot,
the earnest money deposited by him and, in case the plot when put to fresh auction because of default
in payment of the balance amount, execution of lease deed etc, fetches an amount lower than the
amount earlier fixed in bid for, to pay the difference within such period as will be allowed by
Additional District Magistrate failing which to agree to the recovery of the dues as a public demand.
17. Confirmation of the sale by the Commissioner:-
(1 ) As soon as the auction is over, the Additional District Magistrate shall, with the approval of the
Collector, Sundergarh, forward the names of the successful bidders along with the bid lists and other
relevant records to the Commissioner for confirmation.
19. Sanction of lease:-
After the expiry of the appeal period, the Additional District Magistrate shall issue orders sanctioning
the lease in all cases in respect of which the bids are confirmed by the Commissioner and calling upon
the successful bidders in whose favour the bjds have been confirmed to deposit the balance amount
.payable, execute the lease deed in the prescribed form and get it registered at their own cost.
Provided that no such orders shall be issued in respect of plots regarding which appeals have been
filed in his office.
20. Appeal: -
(1) An appeal by a bidder against the order of the Commissioner confirming or rejecting the highest
bid in any case, if presented within thirty days of the date or publication of the lists of Successful
bidders, shall lie to Government in the Revenue Department.
(2) The Petition of appeal shall bear court fee stamps worth rupees two and paise sixty only or as may
be notified by Government from time to time, stating clearly, the grounds of appeal and shall be filed
before the Additional District Magistrate.
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(3) On receipt of the petitions of appeal the Additional District Magistrate shall acknowledge it and
shall within a week of the expiry of the appeal period, forward them along with the bid lists, order of
the Commissioner, etc., in original giving his comments if any, to the Secretary to Government in the
Revenue Department.
(4) Orders of Government on the petition of appeal shall ordinarily be communicated, to the
Additional District Magistrate within four months from the date of receipt of the appeal petition.
(5) On receipt 01 orders oi Government the Additional District Magistrate shall intimate the applicant
and where necessary, issue orders sanctioning lease in the manner indicated in sub-clause (1) of
clause 8.
(6) Orders passed on appeal shall be final.
21. Refund of earnest money:-
Earnest money received from the bidder's unless forfeited under clause 16 shall be refunded within
fifteen days from the date of expiry of the appeal period of within fifteen days from the date of
disposal of the case in appeal, ii any.
22. Government to allot lands to departments of Government, Departmental Committee:-
Allotment of lands to offices of State or Union Government shall be made by the Collector to the
extent, not exceeding one acre by the Commissioner where the area exceeds one acre but does not
exceed 5 acres, by the Member, Board of Revenue where the area exceed five acres and does not
exceeds ten acres and by the Government in respect of the area, exceeding ten acres.
23. Additional District Magistrate to administer these Rules:-
The Additional District Magistrate will be responsible for administration of the provisions made in
this Schedule and in all matters connected with allotment of land for different purposes subject to the
administrative control of the Collector, Sundergarh and the Commissioner.
24. Clarification of doubts :-
( 1) Doubts arising or clarification needed about provisions made in the Schedule shall be referred to
Government in the Revenue Department for decision.
(2) In case of any point of reference relating to the approved master plan, the clarifications shall be
issued after consultation with the Urban Development Department:
25. Issue of executive instructions:-
All matters relating to maintenance of accounts; payment of dues to the Regional Improvement Trust.
Rourkela or any other Organisation shall be regulated by such instructions as would be issued from
time to time by the Government in the Revenue Department.
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FORM-I
Standard form of lease Deed for Lease of Government Lands Allotted on Application in the Rourkela
Civil Township
THIS INDENTURE made on the ………….day of ……….19 between the Governor of Orissa
(hereinafter called the "lessor" which expression shall, where the context so admits or implies, include
his Successors in office and assignees) of the one parts.
AND
Shri …………………………. Son of …………………………….. age ……….. Years, resident of village

…………………….. P. S ………………. , District ,. ……… (Hereinafter called the "Lessee" which
impression shall where the context so admits or implies include his heirs executors administrators
and assignees) of the other part.
WHEREAS the land described in the Schedule below is situated within the Rourkela Civil Township.
AND WHEREAS: - the Committee having allotted the land to the leasee for a premium of Rs…
Rupees ………. )the Additional District Magistrate has sanctioned the lease by order dated and the
lessee has paid the premium in full;
NOT THIS INDENTURE WITNESSETH: that the lessor both hereby grant and the lessee both hereby
accept a lease for the purpose of ………………… on the land specified in Schedule below with effect
from the date of execution of this lease for a period of ninety years subject to the terms and conditions
mentioned below:-
1. The lessee shall pay annually to the Additional District Magistrate or such other office authorised
by him to receive the same as rent for his holding the sum of Rs …………… till the rent is revised
under clause 2.
2. The rent of the holding shall be liable to enhancement at the end of each (20) Twentieth year subject
to the maximum limit of (50) fifty per cent over the rate of rent in force in the previous year.
3. The rent shall become payable in two equal half yearly installment, i, e., on the 15th July and 15th
January of every year
4. The lessee shall construct a house or other building of such description and dimensions as may be
approved by the Regional Improvement Trust, Rourkela within a period of three years from the date
of this lease.
5. (a) The lesses shall not commit any act of waste on his holding so as to 18nder it unfit for the
purpose of being used as a 11ouse site.
(b) The lesses shall not use the house or building or its premises for any purpose other than the
purpose for which the lease is granted.
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6. If no house or building is constructed according to the particulars approved by the Regional
Improvement Trust, Rourkela as provided for the Clause - 4 or the lessee contravenes any condition
in Clause 5 ; the Additional District Magistrate after giving one month's notice to the party and after
hearing him if satisfied, .shall determine the lease and the Additional District Magistrate shall have
the right to re-enter immediately on the land on behalf of the lessor and take possession of the site.
7. In the event of re-entry by the Additional District Magistrate in pursuance of Clause 6, the lessee
shall not be entitled to. refund of any premium paid by him and shall not also be entitled to any
compensation whatsoever from the lessor for any improvements of construction affected or made by
him.
8. In the even of re-entry under clause 6, the lessee shall be entitled to remove the materials collected
and construction made, if any from the land at his cost within fifteen days of such re-entry failing
which the Additional District Magistrate shall be entitled to clause such materials or constructions
removed at the cost of the lessee and to sell the same by auction. The lessee will, in that event, be
entitled only to the balance of the sale proceeds after education of the costs and arrears of rent, if any.
9. Notwithstanding the untimely termination of the lease in accordance with clause 6, the lessee shall
be liable for the ground rent fixed for his holding till the date of re-entry.
10. That the lessee shall not by any means or in any way whatsoever bequeath, mortgage, charge,
transfer, assign subject or part with possession of his holding or any portion thereof to any person
without first obtaining the written permission of the Additional District Magistrate save in case of
mortgage of the lease-hold land or any portion thereof in favour of the Life Insurance Corporation of
India for obtaining house building loan from the said Corporation for construction of a house on the
holding or any ;portion thereof. The lessee shall inform the Additional District Magistrate of the
mortgage within fifteen days. Any bequest, transfer, assignment, subletting or parting with
possession of the holding or part thereof without permission in writing as aforesaid shall be
avoidable at the option of the Additional District Magistrate and he may determine the lease and take
possession of the holding or part thereof as the case may be. In case of unauthorized bequest taking
effect from the death of the lessee, the option to take possession will accrue on the date of death of the
lessee.
11. The lessee shall keep the boundaries of his holding unaltered and well defined and point them out
to any officer or person duly authorized by the Additional District Magistrate in writing to inspect
them, when so ordered by the Additional District Magistrate.
12. The lessee shall keep the land free from jungle and all sorts of nuisance and if he fails to do so, on
notice given to him in writing by the Additional District Magistrate, the land shall be cleared up by
the Additional District Magistrate and the expenses incurred hereby shall be recovered from the
lessee after notice as a public demand.
13. It at any time the lessee is found to be in occupation of excess land belonging to Government than
that is covered by the lease, the Additional District Magistrate shall be at liberty to dispossess him
summarily after notice in writing, from the said excess land held without a lessee or license and
dispose of it as he thinks proper and the lessee shall be liable to pay assessment, penalty and fine as
provided under the Orissa Prevention of Land Encroachment Act, 1972.
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14. In the case of any intestate succession on the lessee's death or that of ay subsequent holder holding
wholly or partly hereunder, the successor shall give notice of his succession and the manner thereof,
and apply to have his name entered in the register of the Additional District Magistrate within six
months from the date of death of the person whom he has succeeded. No transfer fee shall be payable
in such a case but it shall be incumbent upon such successor to present to the Collector an application
for mutation of name bearing court fee as prescribed by law.
15. In the event of the lessee's not paying any instalment or premium or rent in full on or before the
dates herein fixed for such payment, he shall, in addition to the arrear, pay interest at the rate of ten
per cent annum, such arrear and all such dues shall be recoverable as public demand.
16. The lessee shall pay all municipal and other local rates and taxes, which may be assessed upon his
holding under any law for the time being in force whether payable by the owner or occupier.
17. On the expiry of the term of the lease, the lessee shall, if he has duly observed all the conditions
thereof, be entitled to its renewal for a further period of ninety years on the same terms and
conditions, the rent being liable to enhancement at each renewal.
SCHEDULE
Signature of the Additional District Magistrate acting in this premises for
and on behalf of the Governor of Orissa
In the presence of witnesses:- Signature of the lessee.
In the presence of witnesses:-
1. 1.
2. 2.
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FORM No.2
Standard Form of Lease-deed for Lease of Government Land allotted through Public Auction in the
Rourkela Civil Township
THIS INDENTURE made on the …………………….day of……………….. 19………… between the

Governor of Orissa (hereinafter called the "lessor" which expression shall, where the context so
admits or implies include his successors in office and assignees) of the one part,
AND
Shri ……………………son of…………………aged…………………. Years……………. resident of

village………………….. P.S. ………………….. District …………………………… (hereinafter called the
"lessee" which expression shall where the context so admits or implies include his heirs, executors
administrators and assignee) of the other part.
WHEREAS the land described in the schedule below is situated within the Rourkela Civil Township ;
AND WHEREAS the Commissioner has confirmed the bid given by the lessee in the public auction
held on and the Additional District Magistrate has sanctioned the lease of the said land to the lessee
by his order, dated……………… and the lessee paid the premium and all other dues in full;
NOW THI S INDENTURE WIITNESSETH that the lessor doth hereby .grant and demises to the lessee
ALL THAT plot of land containing ………………acres in the Rourkela Civil Township as described in
the Schedule hereto for the purpose of thereon TO HOLD the same to the lessee from the
…………………day of …………….. 19 for a term of ninety years PA YING therefore during the said
term a yearly rent of Rs……………………… in each year at the office of the Additional District
Magistrate or such other officer authorized to receive the same and subject to the terms, conditions
and covenants hereinafter appearing, namely :
1 .The rent of the ho1ding is liable to enhancement at the end of I every (20th) Twentieth year subject
to the maximum limit of (50) fifty per ent over the rate of rent in force in the previous year.
2. The rent shall become payable in two equal half-yearly instalments, i.e. on the 15th July and 15th
January of every year.
3. The lessee shall construct a house or other building of such description and dimensions as may be
approved by the Regional Improvement Trust, Rourkela in writing within a period of three years
from the date of this lease.
4. (a) The lessee shall not commit any act of waste on his holding so as to render it unfit for the
purpose of being used as a house site.
(b) The lessee shall not use the house or building or its premises for any purpose other than the
purpose for which the lease is granted.
5. If no house of building is constructed according to the particulars approved by the Regional

Improvement Trust, Rourkela as provided for in clause 3 or the lessee contravenes the conditions in
clause 4 the Additional District Magistrate shall, after giving one month's notice in writing and after
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giving a reasonable opportunity of hearing to the party, if satisfied about the breach as aforesaid,
,shall determine the lease and have the right to re-enter immediately on the lands on behalf of the
lessor and take possession of the site.
6. In the event of re-entry by the Additional District Magistrate in pursuance of clause 5 the lessee
shall not be entitled to any compensation whatsoever from the lessor. for any improvement or
constructions effected or made by the lessee except that in the event of such re-entry the lessee shall
be entitled to remove the materials collected and construction made, if any, from the land at his cost
within, fifteen days of such re-entry, failing which the Additional District Magistrate shall be entitled
to cause such materials or constructions removed at the cost of the lessee and to sell the same by
auction. The lessee will, in that event be entitled only to the balance of the sale proceeds after
deduction of the cost and arrears or rent, up to the date of re-entry if any.
7. The lessee shall not by any means or in any way whatsoever bequeath mortgage, charge transfer,
assign, sublet or part with possession of his holding or any portion thereof to any person without first
obtaining the written permission of the Additional District Magistrate in case of mortgage of the lease
hold or any portion thereof in favour of the Life Insurance Corporation of India for obtaining a house
building loan from the said Corporation for the construction of a house on the holding or any portion
thereof. The lessee shall inform the Additional District Magistrate. of the mortgage within fifteen
days. Any bequest transfer assignment, subletting or parting with possession of the holding or part
thereof without the permission of the Additional District Magistrate obtained in writing shall be
voidable ail the option of the Additional District Magistrate and ha may determine the lease and take
possession of the holding or part thereof. In case of an unauthorised bequest taking effect after the
death of the lessee, the options to take possession will accrue on the death of the lessee.
to any officer or person duly authorized by the Additional District Magistrate in writing to inspect
them, when so ordered by the Additional District Magistrate.
9. The lessee shall keep the land free from jungle and all sorts of nuisance and if he falls to do so on
notice given to him in writing by the Additional District Magistrate, the land shall be cleared by the
Additional District Magistrate and the expenses incurred thereby shall be recovered from the lessee
after notice, as public demand.
10. If at any time the lessee is found to be in occupation of excess land belonging to the Government
than that is covered by lease the Additional District Magistrate shall be at liberty to dispossess him
summarily after notice in writing, from the said excess land held without a lease of licence and
dispose of it as he thinks proper and the lessee shall be liable to pay assessment penalty and fine as
provided under the Orissa Prevention of Land Encroachment Act, 1972.
11. In the case of any intestate succession on the lessee's death or that of any subsequent, holder
holding wholly or partly there under, the successor shall give notice or his succession and the manner
thereof and apply to have his name entered in the register of the Additional District Magistrate within
six months from the date of death or the person whom he has succeeded. No transfer fee shall be
payable in such a case but it shall be incumbent upon such successor to present to the Collector an
application for mutation of name bearing court fee prescribed by law.
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12. In the event of the lessee's not paying any instalment or premium or rent in full on or before the
dates herein fixed for such payment, he shall, in addition to the arrear, pay interest at the rate of ten
per cent annum, such arrear and all such dues shall be recoverable as public demand.
13. The lessee shall pay all municipal and other local rates and taxes, which may be assessed upon his
holding under any law for the time being in force whether payable by the owner or occupier.
14. On the expiry of the term of the lease, the lessee shall, if he has duly observed all the conditions
thereof, be entitled to its renewal for a further period of ninety years on the same terms and
conditions, the rent, being liable to enhancement at each renewal.
SCHEDULE
Signature of the Additional District Magistrate acting in his premises for and on behalf of the
Governor of Orissa.
1.
2.
Signature of the lessee.
…………………………………..
1.
2.
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RULES FOR LEASE AND SETTLEMENT OF KHASMAHAL, NAZUL
LAND , GRAMAKANTHA PARAMBOK and ABADI LANDS WHICH WERE LEASED OUT
PRIOR TO THE 9TH JANUARY ,1991
1. Manner of recording of leases, sub-
Ieases etc. in respect of Nazul / Khashmhal lands, payment of Compensation:-Tahasildar shall record
the holder of Khasmahal / Nazul lease hold land as a lessee if such land was leased out prior to the
9th day of January 1991. The holder of such land includes a lessee, sub-lessee and a subsequent sub-
lessee. This provision shall not apply to cases of Khasmahal /Nazul lease hold lands utilized for
homestead purposes in any urban area.
(b) Before recording as a lessee/sub-
lessee and subsequent sub-lessee as provided under sub-clause (a) above, the Tahasildar shall satisfy
himself that the lease for the land was granted prior to the 9th day of January 1991, and that sub-
lessee and subsequent sub-lessee held the land as such before the said date with reference to record of
rights and other relevant records. In each such case, the Tahasildar should make field enquiry and
obtain the approval of the Collector.
(c) In the event of sub-
lessees and subsequent sub-lessees being recorded as lessees the person immediately under whom
they were holding the land as such shall be entitled to a compensation equal to an amount ten times
the annual rent stipulated in the lease agreement.
(d) The sub-lessee or the subsequent sub-
lessee shall produce a stamp receipt in Form I before the Tahasildar within a period of six months
from the date he is recorded as lessee in support of payment of such compensation to the person
immediately under whom he held the land.
(e) On failure of production of the stamped receipt in the manner indicated in sub-
clause (d), the Tahasildar shall proceed to recover the compensation as an arrear land revenue and
shall pay the same to the persons entitled to it.
(f) All the lessees so recorded in the manner indicated in the preceding sub-
clauses shall execute a lease deed in Form Ill.
2. Settlement of GramakanthaParambok / Abadi land:-
(a) The Tahasildar shall settle GramakanthaParambok / Abadi land with the person in occupation of
such land for a period of not less than five years as on the appointed day on the following manner,
namely :-
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(i) In urban areas such land used only for the non-homestead purposes shall be settled on lease hold
basis subject to execution of a lease deed in Form III.
(ii) In rural areas such land shall be settled on raiyati basis irrespective of the use of land and the rent
thereof shall be assessed in accordance with that of similar lands in the vicinity.
(b) The procedure for the settlement of the land under sub-clause (a) shall be a follows :-
(i) The Tahasildar shall initiate a case record suomotu or an application from the occupants of such
land and make a detailed enquiry into the possession of such land and ascertain the actual extent of
land under possession of any person.
(ii) On the basis of the enquiry, plotting of the land under possession shall be made and after
preparing the necessary map, the Tahasildar shall issue proclamation inviting objections for
settlement of the land with that individual.
(iii) The proclamation shall be published in the manner provided in sub-rule (5) of rule 5 by giving
thirty days, time to file objections, if any.
(iv) Where objections have been received within the period so specified, the Tahasildar shall dispose
of the same after notice to the concerned parties and by giving an opportunity of being heard to all
such parties.
(v) The Tahasildar after disposing the objections, if any, and where no objections has been received,
may settle the land with the person found to be in actual possession of the land after obtaining prior
approval of the Collector .
3. Nazul/Khasmahal lands used as homestead in urban area:-
Tahasildar on being satisfied after enquiry that any Nazul / Khasmahal land is used and in
occupation by any person as homestead for a period of not less than five years as on the appointed
day shall settle the said land in favour of the person holding such land, on execution of lease deed in
Form IV. In case of a sub-lessee and subsequent sub-lessee such settlement shall take effect on
production of the stamped receipt in Form I from the date of payment of such compensation to the
person (s) immediately under whom they held the land :
Provided that on each such settlement, approval of the Collector shall be obtained.
(b) The amount of compensation shall be equal to ten times of the annual rent as provided in the lease
deed.
4. Settlement of GramakanthaParambokAbadi land, used as homestead in urban area:-
(a) In case of GramakanthaParambok / Abadi land utilized as homestead in the urban, areas, the
Tahasildar shall initiate a case record suomotu on application in Form II from the occupants of such
land and after making a spot enquiry, shall find out individual occupation of the land, determine area
of such occupation and prepare a map of the area assigning separate plot/plots for each such
occupation.
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(b) After such field inspection and preparation of map, the Tahasildar shall record a finding as to the
period of actual occupation by such person if exceeded five years as on the appointed date.
lf the Tahasildar is satisfied with regard to eligibility of such person, he shall issue a proclamation
inviting objections for settlement of the land.
(c) The procedure laid down in sub-clause (b) of clause 2 shall be followed in the matter of publication
of proclamation and disposal of the objections.
(d) Settlement of land shall be made after obtaining prior approval of the Collector and on, execution
of a lease deed in Form IV. The rent of such land shall be fixed with reference to that of similar lands
in the vicinity.
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APPLICATION FOR SETTLEMENT OF GRAMAKANTHA
PARAMBOK AND ABADI LAND
To
The Tahasildar....... ,
1.(a) Name of the applicant :
(b) Age :
2. Father's name :
3.(a) Present residential address (in full) :
(b) Permanent Home address (in full) :

4. Occupation of the applicant:
5. Extent of GramakanthaParambok/ Abadi land in his occupation
(Delete which is not applicable) :
6. Date from which in occupation :
7. Detailed particulars of the land .applied for-
(a) Name of village/Urban area :
(b) Holding No./Plot No./Khata No., if any:
(c) Area applied for
(d) Boundary:
8. Manner of utilisation of larid under occupation. :
Date ,..................................... Signature of the

Applicant
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STANDARD FORM OF LEASEDEED FOR LEASE OF KHASMAHAL,
NAZUL, GRAMAKANTHA PARAMBOK AND ABADI LAINDS USED FOR PURPOSES OTHER
THAN HOMESTEAD IN URBAN AREA
This indenture made the …………….day of………….... 19……………….. ... BETWEEN THE Governor
of Orissa (hereinafter called the "Lessor" which expression shall where the context so admits or
implies include his successors in office and assigns) of the one part.
AND
Shri...………………………………S/o Shri... …………………………..aged……..... years resident of

village.……………………….. P.S... ……………..,District... ………………………..(hereinafter called the
"lessee" which expression shall where the context so admits or implies include his heirs/executors
and assigns) .of the other part.
NOW THIS INDENTURE .WITNESSETH that the lesser doth hereby accept the aforementioned
person as lessee/raiyat in respect of the land in question clearly described in the Schedule below
subject to the terms and conditions hereinafter mentioned :
1. The lessee/raiyat shall pay annually to the Tahasildar as rent the sum Rs…….. being the rent
payable by tenants for similar lands in the vicinity and will also pay cess as per Rules. Such rent is
subject to revision at the time of settlement and resettlement operation
2. The above rent shall be paid in one instalment on or before the 31st March of each year. In the event
of the lessee falling to pay any instalment of rent on or before the above date, such arrears shall carry
interest at the prescribed rates from the date on which the same become payable until payment.
3. That the lessee shall not mortgage or transfer by sale or gift or otherwise his holding or any part
thereof without the previous written permission of the Collector and keep the land free from
encroachment.
4. The lease held land shall not be utilized for any other purpose except for the purpose for which it
has been assigned without specific permission from the Collector nor the land shall be made unfit for
such use.
5. In case of any transfer of the holding or part thereof or in case of intestate succession on the lessee's
death or that of any subsequent holder holding wholly or partly the lease hold land it will be
incumbent upon the person on whom the said land devolves to make an application to the Tahasildar
under whose jurisdiction the land is situated for necessary mutation.
6. It the land or any part thereof is required by Government at any time for any public purpose, the
said land or part thereof can be resumed by giving a three month's notice in writing. In such an event
the lessee can claim compensation for any building erected or other improvement that he might have
done on the said land. The amount of such compensation will be fixed by the Collector whose
decision shall be final, Conclusive and binding on the lessee.
79 | P a g e
7. The lessee shall pay all municipal and other local taxes which may be assessed upon the demised
premises under any law for the time being in force.
8. In case of breach of either of the provisions of Clause 3 or 4 of this lease agreement by the lessee, the
lease shall be determined and the Collector on behalf of the lessor shall have the right to re-enter
immediately and take possession of the said land.
9. That in the event of re-entry provided in clause 8 hereof, the lessor shall not be liable to pay any
compensation for any improvement effected or made by the lessee :
SCHEDULE OF THE LAND
Signature of the Tahasildar acting in the
premises for and on behalf
Government of Orissa.
In the presence of witnesses:
in the presence of the witnesses Signature of the Lesses
1. 1.
2. 2.
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FORM IV
STANDARD FORM OF LEASE DEED FOR LEASE OF KHASMAHAL,NAZUL,

GRAMAKANTHA PARAMBOK AND ABADI LAND USED FOR HOMESTEAD PURPOSES IN
URBAN AREA.
This indenture made on the ………………….day of.………………19 ………….. BETWEEN the

Governor of Orissa (hereinafter called the 'Iessor' which expression shall, where the context so admits
or implies includes his successors in office and assignees) of the one part,
AND
Shri ………………………….. s/o Shri ……………………………….aged …….. years resident of village

………………….P.S …………….District ………………(hereinafter called the assignee which
expression shall where the context so admits or implies include his heirs / executors and assigns) of
the other part.
NOW THIS INDENTURE WITNESSETH that the lessor do hereby accept the aforementioned person
as the assignee on payment basis In respect of the Khasmahal /Nazul/ GramakanthaParambok /
Abadi lands described in the schedule below, subject to the terms and conditions hereinafter
mentioned :-
1. The assignee shall pay annually to the Tahasildar as rent the sum of Rs ………….. being the rent
payable by tenants for similar lands in the vicinity and will also pay cess as per Rules.
2. That the assignee shall not commit any act of waste on his holding so as to render it unfit for the
purpose of being used as a homestead.
to any officer or person duly authorised by the Collector in writing to inspect them when so ordered
by the Collector.
4. In the case of any transfer of the holding or part thereof in case of intestate succession on the
assignee's death, it will be incumbent upon the person on whom the said land devolves to make an
application lo the Tahasildar under where jurisdiction the land situates for necessary mutation.
5. If the land or any part thereof is required by Government at any time for any public purposes, the
said land or part thereof can be resumed by giving a three months’ notice in writing. In such an event,
the assignee can claim compensation for any building erected or other improvement that he might
have done on the said land. The amount of such compensation will be fixed by the Collector whose
decision shall be final, conclusive and binding on the assignee.
6. The lessee shall pay all municipal and other local taxes which may be assessed upon the demised
premises under any law for the time being in force.
SCHEDULE OF THE LAND
Signature of the Tahasildar acting
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In the premises for and on behalf of
the Governor of Orissa.
In the presence of witness Signature of the Lesses
in the presence of the witnesses
1. 1.
2. 2.
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OPLE (Orissa Prevention of Land Encroachment Act, 1972)
Notice under Section 9 of the O. P. L. E. Act, 1972
To
Shri ………………………. s/o ………………………..
Address:
Whereas it appears that you are in unauthorised occupation of land as specified in the
Schedule below which is the property of Government, you are hereby given notice to appear before
the undersigned personally or through authorised agent on …………………at …………………..and
show cause why you should not be proceeded against under Sections 4 and 6 of the Orissa Prevention
of Land Encroachment Act, 1972 (Orissa Act 6 of 1972).
SCHEDULE
Name of the Plot Description Entire extent Extent Nature of

village, Police No. of the plot as unauthorisedly occupation
Station or Thana recorded in occupied
and District record-of-
rights
1 2 3 4 5 6
Date: ........................... Tahasildar
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Notice under Section 9/7 (1) of the O. P.L E. Act, 1972
[See Rule 6 (1)']
To
Shri... ……………………son of.......................
Address:
Whereas after due enquiry the undersigned is satisfied that you are in unauthorised occupation of the
land specified in the Schedule below, which is the property of Government, you are hereby given
notice to remove the encroachment within thirty days from the date of receipt of this notice failing
which you will be summarily evicted from the land and any crop or other product raised on the land
or any encroachment such as a building erected or a thing deposited thereon shall be liable to
forfeiture.
SCHEDULE
Name of the village, Plot Entire extent of the plot Extent Nature of
Police Station or No. as recorded in record- unauthorisedly occupation
Thana and District of-rights occupied
1 2 3 4 5
Date: ........................... Tahasildar
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Order under Section 8 of the O. P. L. E. Act, 1972
[ See Rule 6 (2) ]
Prohibitory order against construction or continuance of any building or

structure on any un-authorisedly occupied land
To
Shri........................................ S/o................................
Address:
Whereas the undersigned has reason to believe that you are unauthorisedly constructing/about to
construct a building or other structure on the land which is the property of Government as defined
under Section 2 of the O. P. L. E. Act, 1972, it is hereby ordered that you be and you are hereby
prohibited from continuing the said construction/ structure further:
SCHEDULE
Name of the Plot Description Entire extent of Extent Nature of

village, Police No. the plot as unauthorisedly occupatio
Station or Thana recorded in occupied n
and District record-of-rights
1 2 3 4 5 6
Date: ........................... Tahasildar
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[ See Rule 9 )
Form of warrant of arrest to be issued by the Tahasildar
To
The Officer-in-Charge, Seal
Police Station
Whereas Shri ……………………………s/o of …………………….village/police-station

………………….has resisted/obstructed the officer deputed to remove him from unauthorized
occupation of Government land in plot………………….. of holding No……………………… has failed
to comply with my order prohibiting him from
constructing the buildings/structure on the said land and it is necessary to send him for
imprisonment in the Civil Jail under Sections 7 (6) and 8 of the O. P. L. E. Act, 1972 you are hereby
directed to arrest the said ………………and produce him before me.
Dated this ………………day of 20…………… (Strike out which is not applicable)
Seal Signature of Tahasildar
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FORM 'E'
( See Rule 15 (5) ]
In the Court of Shri………………………… Magistrate ……………………….

I, Shri ……………………….aged ………………years, son/daughter/wife of …...........resident of Ward
No……………………….. Municipality/Notified Area,
P. O …………………P.S……………………… in the district of………………………… at
present…………………………… by profession……………….. do hereby................., solemnly affirm as
follows:
1. That I or any of my family members living with me in common mess do not own or possess any
residential house/building or house site anywhere in the State of Orissa.
2. That the land measuring acres pertaining to Plot No ……………………Khata No ……………in the
Municipality/Notified Area/Urban Area now under my unauthorised occupation is adjacent to my
holding.
3. That the encroached land shown under item 2 above is necessary for beneficial enjoyment of my
holding/for my residential, purpose.
4. That I have not been considered for any home-stead/plot in .any Municipality/Notified
Area/Urban Area.
5. That I solemnly swear and affirm that the above statement are true to my knowledge and belief and
I also swear that I have not concealed anything regarding existing house or house site owned either
by me or by any of my family members. I swear the affidavit this the day of…………..
Identified by me Signature of the Deponent Advocate
Shri...................................... aged…………………… years, son/daughter/wife

of…………………. resident of village/town/Municipality/Notified Area/Urban
Area…………………. P. O. ………../P.S ………….., in the district of…………… at present by
profession ………………..who is identified by Shri ……………Advocate, appears before me and states
on oath that contents of this affidavit are true to the best of his knowledge and belief.
(Strike out which is unnecessary)
Deponent Magistrate (Seal)
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[ See Sub-rules (4) and (8) of Rule 15 ]
O
Intimation slip for settlement of land
f
fice of the Tahasildar……………………..
District……………………………………………
Case No of........................................
Name of the village/Municipality/Notified Area/Urban Area……………………….. (If
Municipality or Notified Area mention Ward No.)
Thana No. of the village………………………………………………
Name of the person in whose favour land is ordered for settlement ……………..
Father's name …………………………………
Caste Address…………………………………..
Holding No……………………………………….
Plot No………………………………………………..
Khata No ……………………………………………
Area leased out………………………………………
Classification of the land…………………………….
Amount of assessment/penalty/fine………………
Purpose of settlement of land …………………….
Status Remarks…………………………………………
Certified that the above particulars have been incorporated In the relevant record-of-rights.
Tahasildar
Certified that the above particulars have been incorporated in the circle records.
Revenue Inspector
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FORM 'G'
[ See Rule 3 (1) J
Statement of unauthorised occupation of Government land in

village of ........in the circle…………………..Tahasil...................Subdivision……………………...District...
……………...during the month………….. of 20 ……………
1. Serial No ……………………….
2. Name, father's name and address of the person in unauthorised
occupation
3.Whether the person belongs to Scheduled Caste or Scheduled Tribe
4. Description of the land unauthorisedly occupied-
(a) Village, Thana and Tahasil
(b) Holding No
(c) Plot No
(d) Full extent of the plot
(e) Extent occupied with boundary
5. Class of lands encroached, i. e., whether-
Gochar, Canal, Embankment, Rakhit, Sarbasadharana, set apart for common use of villagers used for
house site, temple site, likely to be required for any development scheme, belongs to an establishment
of Government/company/corporation
6. Whether the land is In Rural Area/Municipality/Notified Area/ Urban area
7. If the land is in Municipality or Notified area whether
(i) the person or any member of his family living with him in common mess owns a house or house
site in that Municipality or Notified Area,
(ii) the land, being adjacent to the holding owned by the person, is necessary for the beneficial
enjoyment of such holding or for the residential purpose of the person, or
(iii) the land Is reserved for the purposes of any Government or
for any development purpose.
8. Whether the person is landless and, if not-
(a) the total extent of land owned by him (excluding his home stead),
(b) extent of lands owned by all the members of his family who
are living with him in common mess, and
(c) extent of home-stead land owned by him.
9. Income of the encroacher and other members of the family living jointly with him in one mess from
sources other than agriculture..-
10. Mode of occupation by-
89 | P a g e
(i) cultivation
(ii) erection of house
(iii) any other manner
11. Date of inspection of the Revenue Inspector
12. Whether encroachment was blocked previously, if so, the case No
13. Rate of assessment (Taram assessment of the village)
14. If not assessed, rate of assessment of lands of similar description
and advantage in the vicinity
15. Assessment of the extent occupied
16. Remarks of the Revenue Inspector
Signature in full of the Reporting Officer
(Revenue Inspector)
90 | P a g e
(Register on Encroachment)
[ See Rule 3 (2) ]
1. Serial No
2. Date..
3. Name of village .
4. Name of the Encroacher, Caste, his father's name and address
5. Khata No
6.Classification and status
7. Plot No
8. Area encroached
9. Mode of encroachment
10. Date of receipt of report from Revenue Inspector
11. Assessment
12.Penalty
13.Fine ,
14. Market value
15. Date of disposal and by whom disposed of
16. Purport of the order
17. Date of settlement, if any, and purpose ;
18. Date of vacation/eviction
19. Remarks of the Tahasi1dar which may include-
(a) The amount of sale proceeds of crop or other materials forfeited, if any
(b) Report of Revenue Inspector incorporating the amount in the village demand
(c) If appeal filed, the date of appeal and the decision of appellate Court
91 | P a g e
Register showing Government land likely to be required
for any Development Scheme
[See Rule 14 (3)]
1. Name of the village

2. Classification of land
3. Khata No
4. Plot No
5. Area
6. Purpose for which reserved
7. No. and date of the Notification declaring the area likely to. be required for any
development scheme
8. Remarks
Tahasildar
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FORM 'J'
[See Rule 15 (1)]
It is proposed to settle the land mentioned In the Schedule below in favour of s/o...
..................Caste.......................
Village …………….who has encroached the said land being the property of Government.
Any person intending to raise objection to the proposed settlement may file his objection
before the undersigned within fifteen days of the publication of this notice at……………..
Tahasil office. If no objection is filed till the expiry of the said period, the undersigned will
proceed to settle the land in favour of the encroacher:
SCHEDULE
Name of the Plot Description Entire extent of the Extent Nature of

village, Police No. plot as recorded in unauthorisedly occupation
Station or Thana record-of-rights occupied
and District
1 2 3 4 5 6
Tahasildar
93 | P a g e
Registration
GENERAL SEARCH APPLICATION
1. Name of the applicant and address
2. Village / hamlet/ town and street in which the property is situated
3. Description of the property (Khata / Plot No. & area) with boundaries in case of part
plots
4. The year(s) in the books of which search should be made
5. The additional year(s) in the books of which search should be continued
Please search the books of your office and grant of certificate of encumbrance on the
above mentioned property
Date................... 20... Signature of applicant
I declare that to the best of my knowledge the above items constitute a single property
and belong at present to .......................................................................
Signature of applicant
GS No. ................................. 20....
Search made in Search fee ....... Index ............................................. for years 20....
Documents found
Vide
Encumbrance certificate.......................... File No......................................
Page:
Search made by
Certificate prepared by:
Certificate verified by.
94 | P a g e
Form -23
APPLICATION FOR SEARCH OR INSPECTION
1. Date of application
2. Name of the office where the document was

registered, filed or recorded
3. Year or years to which the search or inspection

relates.
4. Name and residence of applicant
5. Applicant interest in the deed (Executant or

claimant or representative or agent of )
6. Number of Index to be searched (I, II, III or IV)
7. Name of the person to be searched. In case of

E.C., description of property to be searched may
be given on a separate sheet of paper if the same
does not contain in Col. 7.
8. Description of Book Register of file with Name of

parties to be inspected in case of book, I, III, or IV
also the document and volume No.
9. Amount of searching Searching Fees

or inspection fees
Inspection Fees
Signature of the Applicant
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FORM No. 25
NIL CERTIFICATE OF ENCUMBRANCE ON PROPERTY
Certificate No. of 20....
Application No. of 20
Name
having applied to me for a certificate given particulars of registered acts and encumbrances,
if any, in respect of undermentioned property:—
I hereby certify that a search has been made in Book 1 and in the indexes relating
thereto for years from the day of 19 to the day of 19
for acts and encumbrances affecting the said property and that on such search no acts or
encumbrance affecting the said property has been found.
Search made and certificated

prepared by
Search made and certificated

examined by
SIGNATURE OF REGISTERING OFFICER
Note—(1) If the properties have been described in registered documents in a manner

different from the way in which the applicant has described them in the
application the transactions evidenced by such documents will not be included in
the certificate.
(2) Under Section 57 of the Registration Act and Rule 137 (i), persons desiring to
inspect entries in the registers and indexes; or requiring copies thereof, or
certificates of encumbrances on specified properties should make the search
themselves, when the registers and indexes will be placed before them on
payment of the prescribed fees,
96 | P a g e
(a) But as in the present case the applicant has not undertaken the search himself, the
requisite search has been made as carefully as possible by the Offices but the
department will not, on any account, hold itself responsible for any errors in the
results of the search embodied in this certificate.
(b) And as in the present case the applicant has made the requisite search himself and
as its result is shown in the certificate after the necessary verifications the
department wilt not on any account, hold itself responsible for the omissions in it
of any acts and encumbrances effecting the said property, not discovered by the
applicant.
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FORM No. 26
CERTIFICATE OF ENCUMBRANCE ON PROPERTY
Certificate No. of
Application No. of
Name
Having applied to me for a certificate giving particulars of registered acts and encumbrances,
if any in respect of undermentioned property :—
I hereby certify that a search has been made in book... ,and in the indexes relating
thereto for years from the day of 19 to the day of 19 for acts and
encumbrances affecting the Mid property, and that on such search the following acts and
encumbrances as detailed on the reverse appear.
I also certify that save the aforesaid acts and encumbrances no other acts and
encumbrances effecting the said property have been found.
Search made and certificate Signature

prepared by
Designation
Search verified and certificate Signature

examined by
Designation
Signature of Registering Officer
98 | P a g e
Note—(1) The acts and encumbrances shown in the certificate are those discovered with
reference to the description of properties furnished by the applicant If the same
properties have been described in registered documents in a manner different
from the way in which die applicant has described the transactions evidenced by
such documents will not be included in the certificate,
(2) Under Section 57 of the Registration Act and Rule 137 (i), persons desiring to
inspect entries in the registers and indexes, or requiring copies thereof or requiring
certificates of encumbrances on specified properties should make the search
themselves, when the registers and indexes will be places before them on payment
of the prescribed fees.
(a) But as in the present case, the applicant has not undertaken the search himself, the
requisite search has been made as carefully as possible by the office; but the
department will not on at account hold itself responsible for any errors in the
results of the search embodied in this certificate.
(b) And as in the Present case, the applicant has made the requisite search himself and
as the acts and encumbrances discovered by him are shown in the certificate, after
verification, the department will not, on any account, hold itself responsible for
the omission in it of any other acts and encumbrances affecting the said properties
not discovered by the applicant.
Seria (a) Date of (b) Names and Parties Reference to documents

l No. Descriptio executio Nature entry
n of n and
Executive Claimant Volum Pag Numbe
Property value of
s s e e r
documen
and
t
Year
1 2 3 4 5 6 7 8 9
(a) Enter the description as given in the document found
(b) (1) In the case of a mortgage-deed enter rate of interest and period of payment if stated
therein
(2) In the case of leases enter term of lease and annual rental
99 | P a g e
FORM No. 27
CERTIFICATB SHOWING LIST OF DOCUMENTS EXECUTED BY OR IN FAVOUR OF A

PERSON
Certificate No.................. .of
Name Application No................ of
having applied to me for a certificate giving particulars of registered documents(s) executed by or in

favour of............................................................................ I hereby certify that a search has been made for
such document(s) to Book 1, 3 and 4 and in the indexes relating thereto for the years from the...............
day of.................... 19.................... to the............. day of .................. 19 ................ and that on such search
the following appear :—
Date of Interest of Name of Reference to document entry

registration person in person Book Volume Page Number
the and Year
transaction
1 2 3 4 5 6 7
I also certify that save the aforesaid documents no other entries have been found. Documents
registered to Book 3 or 4, copies of which, the applicant is not entitled to obtain under the provisions
of Section 57 of the Registration Act, are not covered by this certificate.
Search made and certificate prepared by ........................................................

(Signature/designation)
Search verified and certificate compared by ....................................................

(Signature/designation)
Office Signature of Registering Officer
Dated ....................... (Seal)
NOTE - (1) The documents shown in the certificate are those discovered with reference to the
description of the person furbished by the applicant. If the name has been described in
registered document in a manner different from the J way in which the applicant has
described it, transactions evidenced by such documents will not be included in the
certificate.
(2) The requisite search has been made as carefully as possible by the office but the
department will not on any account hold itself responsible for any errors in the result of
the search embodied in this certificate.
100 | P a g e
NOTICE OF INTENDED MARRIAGE
To
Marriage Officer, ........................................., of District - Cuttack
We hereby give you notice that a marriage under the Special marriage Act, 1954, is intended to
solemnised between us within three calendar months from the date hereof.
BRIDEGROOM BRIDE
1. Name
Son/ Daughter of
2. Condition Unmarried/ Widower/ Unmarried/ Widower/

Divorcee Divorcee
3. Occupation
4. Age/ Date of Birth
5. Dwelling Place
6. Permanent dwelling
place if present
dwelling place not
permanent
7. Length of residence
Witness our hands this ......................... day of ...........................................20
Signature of Bridegroom Signature of Bride
Place :
Date :
101 | P a g e
Application for registration of a Marriage under Section 15
of the Special Marriage Act, 43 of 1954
1. Name of the parties
Husband :
Wife :
2. Age or Date of Birth
Husband :
Wife :
3. Permanent dwelling place, if any :
4. Present dwelling place
5. Relationship, if any, of the parties before marriage
6. A ceremony of marriage was performed between
..............................................................................................................................
..............................................................................................................................
at ........................................................... and we declare that we have been living together

as husband and wife ever since the date noted above
We hereby declare that -
(i) Neither of us has more than one spouse living on the date mentioned in this
application nor shall have such at the time of registration,
(ii) Neither of us is an idiot or lunatic,
(iii) Both of us have completed the age of twenty one years on the date of registration,
(iv) We are not within the degrees of prohibited relationship. Our marriage was
celebrated before the commencement of the Special Marriage Act, XLIM of 1954,
102 | P a g e
and according to the law, custom, or usage having the force of law, governing
each of us, a marriage between us is permitted though we are within the degrees
of prohibited relationship according to the Act aforesaid.
Note : Score out whichever]is not applicable,
(v) We have been residing within the jurisdiction of the Marriage Officer
.......................at ....................... for a period of not less than thirty days immediately
preceding the date of this application.
We also declare that all the above particulars are true to the best of our knowledge
and belief.
Signatures
Station: Husband
Date: Wife
103 | P a g e
Land Acquisition
(See rule 3 of the Odisha Right to Fair Compensation and Transparency in Land Acquisition,
Rehabilitation and Resettlement Rules, 2015)
Proposal for Acquisition of Land
1. Name of Requiring Body :
2. Address of Requiring Body
i) Telephone No.
ii) E-mail ID
iii) Fax No.
3. Name or Location of the Project
4. Filed under
(Section 2(1) or 2(2) (a) or 2(2) (b)):
5. Whether proposal is filed u/s 40
(If, yes, reasons thereof)
6. Purpose of acquisition of land:
7. Project Details
i) Village
ii) Gram Panchayat
iii) Block or Municipality or NAC
iv) Tahasil
v) District
8. Whether the area is coming under : Yes No
Scheduled Area.
9. Total Area covered in the project :
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Private Land Govt. Land
Name ( Area in Acre) (Area in acre)
Total
SI. No. of Private land Private (Area in
Private land For lease/ Already
for land to be leased out/ Acre)
village
purchased alienation alienated
acquisition purchased
(1) (2) (3) (4) (5) (6) (7) (8)
Total
10. Area of irrigated multi cropped land or agricultural land other than irrigated multi cropped land:
Extent of irrigated multi Extent of agricultural land Extent of land other Total extent of land for
cropped land other than irrigated double than those mentioned in acquisition
(in acres) cropped land (in acres) columns (1)& (2) (in
acres)
(1) (2) (3) (4)
11. Reasons for inclusion of agricultural and irrigated double -cropped land :
12. Land details:
Khata Plot Area to be Boundaries of land to

District Tahasil Village Total area
No. No. acquired be acquired N/S/E/W
(1) (2) (3) (4) (5) (6) (7) (8)
Name of
Name of present No of No of No.
Classification of
Recorded raiyat residential commercial of Tanks Ponds Wells Remarks
land
raiyat with full house house trees
address
(9) (10) (11) (12) (13) (14) (15) (16) (17) (18)
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13. Whether the certified copies of RoRs are enclosed:
14. Whether the acquisition would be done in different stages:
15. Whether the Detailed Project Report is enclosed:
16. Estimated cost of acquisition component wise as provided under clause
(i) of section 3 of the Act :
17. Three copies of map showing total project area including proposed acquired area, purchased
area and Government land, if any :
18. List of documents attached to the application;
We declare that any subsequent liability arising out of this land acquisition proposal will be
borne by us.
Place:
Date: Signature of the Authorized Officer

of the Requiring Body with seal
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Form- B
Terms of Reference (ToR) for the SIA
The project-specific Terms of Reference (ToR) shall include the followings, namely:-
(1) A brief description of the project, project area and the extent of lands proposed for acquisition;
(2) The objectives of the SIA and all the activities that must be carried out by the SIA team;
(3) Sequencing, schedule and deadlines for deliverables with dates for the SIA process, based on
the size and complexity of the project and land acquisition, and whether consent of Gram
Sabhas and land owners is required to be sought;
(4) The appropriate size and profile of the SIA team required (including field surveyors if needed)
to conduct the SIA for the specific project;
(5) A project-specific budget based on the ToR, with a clear breakup of costs for each item or
activity;
(6) The schedule for the disbursement of funds to the SIA team tied to clearly defined deliverables
in the SIA process;
(7) The processing fee will be determined based on the ToR and budget developed for each
specific project and will be based on the size and location of the project and the land proposed
for acquisition.
Authorized Officer of the State SIA unit
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FORM - C
Government of Odisha
Revenue & Disaster Management Department
Notification
Notification No.
Date:
Whereas the State Government intends to acquire the following lands in consultation with the
concerned Panchayat or Municipality or Municipal Corporation, as the case may be, at village or
ward level, in the affected area and carry out a Social Impact Assessment study for public purpose.
And whereas study shall be undertaken as per the provisions of section 4 of the Right to Fair
Compensation and Transparency in Land Acquisition, Rehabilitation and Resettlement Act, 2013;
Now, therefore, in exercise of the powers conferred by sub-rule (1) of rule 8 of the Odisha
Right to Fair Compensation and Transparency in Land Acquisition, Rehabilitation and Resettlement
Rules, 2015, the State Government do hereby issue this notice for carrying out SIA Study for
commencement of consultation and Social Impact Assessment study on the basis of the following
information, namely; -
i) Name of project developer:
ii) Purpose of proposed acquisition of land:
iii) Organisation to undertake the study:
iv) Contact details of the Organisation:
v) Land details:
District Tahasil Village Khata Plot Total Area to be Name of

No. No. area acquired recorded raiyat
(1) (2) (3) (4) (5) (6) (7) (8)
(a) Brief description of the proposed project:

(b) The project area and the affected areas:
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(c) Whether consent of Gram Sabhas and land owners is required?
(d) The date of commencement of SIA.
(e) The date of completion of SIA:
By order of the Governor
Principal Secretary to Government
Revenue and Disaster Management Department.
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FORM - D
(See sub-rule (2) of rule-9 of the Odisha Right to Fair Compensation and Transparency in Land
Acquisition, Rehabilitation and Resettlement Rules, 2015)
Table of Contents for SIA Report
SI.No Subject Item Contents

(1) (2) (3) (4)
1 Executive Summary i. Name of the Project;
ii. Public purpose;
iii. Location;
iv. Area of the Project;
v. Alternatives considered;
vi. Social Impacts;
vii. Mitigation measures;
viii. Assessment of social costs and benefits.
2 Detailed description of the i) Background of the project, including developers
Project background and governance;
ii) Management structure;
iii) Rationale for project including how the project fits the
public purpose criteria;
iv) Details of project size, location, capacity, outputs,
production targets, cost, risks;
v) Examination of alternatives;
vi) Phases of project construction;
Vii) Core design features and size and type of facilities;
Viii) Need for ancillary infrastructural facilities;
ix) Work force requirements
a)temporary: b)permanent:
x) Details of SIA or EIA if already conducted and any
technical feasibility reports;
xi) Applicable legislations and policies;
3 Team composition, approach, i) List of all team members with qualifications;
methodology and schedule of
the SIA
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(1) (2) (3) (4)
ii) Description and rationale for the methodology and
tools used to collect information for the SIA;
iii) Sampling methodology used;
iv) Overview of information or data sources used;
(Detailed reference must be included separately in
the forms)
v) Schedule of consultations with public representatives
and key stakeholders;
vi) Brief description of public hearings conducted;
vii) Specific feedback incorporated in the report.
4 Land Assessment i) Maps showing area of impact under the project (not
limited to land area for acquisition);
«i) area of impact under the proposed project, including
both land to be acquired and areas that will be
affected by environmental, social or other impacts of
the project;
iii) extent and location of land proposed to be acquired
for the project;
iv) if the land proposed for acquisition is the bare
minimum requirement;
v) possible alternative sites for the project and their
feasibility;
vi) whether, the land proposed for acquisition in
Scheduled Area is a demonstrable last resort;
vii) land, if any, already purchased, alienated, leased or
acquired and the intended use for each plot of land
required for the project;
viii) the possibility of use of any public, unutilized land
for the project and whether any of such land is under
occupation;
ix) nature of the land, present use and classification of
land and if it is an agricultural land, the irrigation
coverage for the said land and the cropping pattern;
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(1) (2) (3) (4)
x) whether the special provisions with respect to food
security have been adhered to in the proposed land
acquisition;
xi) size of holdings, ownership patterns, land
distribution, number of residential houses, and public
and private infrastructure and assets; and
xii) land prices and recent changes in ownership, transfer
and use of lands over the last three years.
5 Estimation and enumeration i) Enumeration of the followings types of families:-
(where required) of affected a) Families whose land or other immovable
families and assets properties have been acquired;
b) Land under occupation of tenants;
c) Families of the Scheduled Tribes and other
traditional forest dwellers who have lost any of
their forest rights;
d) Families of agricultural labourers, tenants or
holding of usufructary right, share- croppers or
artisans or who may be working in the affected
area for three years prior to the acquisition of the
land;
e) Families who have been assigned land by
the State Government or the Central
Government under any of its schemes;
f) Families who have been residing on any
land in the urban areas for preceding three
years or more prior to the acquisition of the
land;
g) Families indirectly impacted by the project
(Gatherers of forest produce, hunters, fisher folk,
boat men, etc.)
h) Inventory of productive assets and significant
lands
6 Socio-economic and cultural i) Demographic details of the population in the project
profile (affected area and area;
resettlement site)
ii) Income and poverty levels;
iii) Vulnerable groups;
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(1) (2) (3) (4)
iv) Land use and livelihood:
v) Local economic activities:
vi) Factors that contribute to local livelihoods:
vii) Kinship patterns and social and cultural organization:
viii) Shrines and sacred places:
ix) Administrative organisations:
x) Political organisations:
xi) Community-based and civil society organisations;
xii) Regional dynamics and historical change processes:
xiii) Quality of the living environment:
7 Social impacts i) Framework and approach to identifying impacts:
ii) Description of impacts at various stages of the project
cycle such as impacts on health and livelihoods and
culture. For each type of impact, separate indication
of whether it is a direct or indirect impact, differential
impacts on different categories of affected families
and where applicable cumulative impacts;
iii) Indicative list of impact areas include-impacts on
land, livelihoods and income, physical resources,
private assets, public services and utilities, health,
culture and social cohesion and gender based
impacts.
8 Analysis of costs and benefits i) Final conclusions on-
and recommendation on
acquisition
ii) Assessment of public purpose:
iii) Less-displacing alternatives and minimum
requirements of land:
iv) Nature and intensity of social impacts:
v) Viability of the mitigation measures and extent to
which mitigation measures described in the SIMP
shall address the full range of social impacts and
adverse social costs:
113 | P a g e
Form - E
(See sub rule (2) of rule 9 of the Odisha Right to Fair Compensation and Transparency in Land
Social Impact Management Plan
(1) Ameliorative measures required to be undertaken for addressing the impact of the project on
(i) livelihood of affected families;
(ii) public and community properties;
(iii) assets and infrastructure particularly roads, public transport;
(iv) drainage and sanitation;
(v) sources of drinking water;
(vi) sources of water for cattle;
(vii) community ponds;
(viii) grazing land; (ix) plantations;
(x) public utilities such as post offices, fair price shops, food storage Godowns, electricity
supply, health care facilities, schools and educational or training facilities, Anganwadis,
children parks, places of worship, land for traditional tribal institutions and burial and
cremation grounds;
1) Measures that the Requiring Body has stated it will introduce in the Project Proposal.
2) Additional measures that the Requiring Body has stated it will undertake in response to the
findings of the SIA process and public hearings.
(The SIM Plan shall also mention key persons responsible for each
ameliorative measure and timelines and costs for each activity.)
114 | P a g e
Form - F
(See sub rule (4) of rule-11 of the Odisha Right to Fair Compensation and Transparency in Land
Socio-Economic and Cultural Parameters
1. Demographic details of the population in the-project area:-
a) Age, sex, caste, religion;
b) Literacy, health and nutritional status;
2. Poverty levels;
3. Vulnerable groups:-
(a) Women, (b) children, (c) the elderly,(d) women-headed households,
(e) the differently abled;
4. Kinship patterns and women's role in the family:
5. Social and cultural organisation:
6. Administrative organisation:
7. Political organisation:
8. Civil society organisations and social movements:
9. Land use and livelihood:-
a) Agricultural and non-agricultural use;

b) Quality of land - soil, water, trees etc.;
c) Livestock;
d) Formal and informal work and employment;
e) Household division of labour and women's work;
f) Migration;
g) Household income levels;
h) Livelihood preferences; and
i) Food security.
10. Local economic activities:-
(a) Formal and informal, local industries;

(b) Access to credit;
(c) Wage rates; and
(d) Specific livelihood activities women are involved in.
115 | P a g e
11. Factors that contribute to local livelihoods:-
(a) Access to natural resources;
(b) Common property resources;
(c) Private assets;
(d) Roads, transportation;
(e) Irrigation facilities;
(f) Access to markets;
(g) Tourist sites;
(h) Livelihood promotion programmes; and
(i) Co-operatives and other livelihood-related associations.
12. Quality of the living environment:-
(a) Perceptions, aesthetic qualities, attachments and aspirations;
(b) Settlement patterns;
(c) Houses;
(d) Community and civic spaces;
(e) Sites of religious and cultural meaning;
(f) Physical infrastructure (including water supply, sewage systems etc.);
(g) Public service infrastructure (schools, health facilities, anganwadi centres, public
distribution system);
(h) Safety, crime, violence; and
(i) Social gathering points for women.
116 | P a g e
Form- G
Key Impact Areas
1. Impacts on land, livelihoods and income:—
(a) Level and type of employment;
(b) lntra-household employment patterns;
(c) Income levels;
(d) Food security;
(e) Standard of living;
(f) Access and control over productive resources;
(g) Economic dependency or vulnerability;
(h) Disruption of local economy;
(i) Impoverishment risks; and
(j) Women's access to livelihood alternatives.
2. Impacts on physical resources: -—
(a) lmpacts on natural resources, soil, air, water, forests ; and
(b) Pressures on land and common property natural resources for livelihoods. 3.
Impacts on private assets, public services and utilities: —
(a) Capacity of existing health and education facilities;
(b) Capacity of housing facilities;
(c) Pressure on supply of local services;
(d) Adequacy of electrical and water supply, roads, sanitation and waste management
system; and
(e) Impact on private assets such as bore wells, temporary sheds etc.
4. Health impacts:—
(a) Health impacts due to in-migration;
(b) Health impacts due to project activities with a special emphasis on impact on women's
health and impact on the elderly.
117 | P a g e
5. Impacts on culture and social cohesion:—
(a) Transformation of local political structures;
(b) Demographic changes ;
(c) Shifts in the economy-ecology balance ;
(d) lmpacts on the norms, beliefs, values and cultural life;
(e) Crime and illicit activities;
(f) Stress of dislocation ;
(g) Impact of separation of family cohesion ; and
(h) Violence against women
6. Impact at different stages of the project cycle:—
The type, timing, duration, and intensity of social impacts will depend on and relate closely to
the stages of the project cycle. Below is an indicative list of impacts, namely:—
(a) Pre-construction phase-
i) Interruption in the delivery of services,
ii) Drop in productive investment,
iii) Land speculation, and
iv) Stress of uncertainty.
(b) Construction phase -
i) Displacement and relocation,
ii) Influx of migrant construction workforce, and
iii) Health impacts on those who continue to live close to the construction site.
(c) Operation phase:-
i) Reduction in employment opportunities compared to the construction phase,
ii) Economic benefits of the project,
iii) Benefits on new infrastructure, and
iv) New patterns of social organisation.
118 | P a g e
(d) De-commissioning phase:-
i) Loss of economic opportunities and
ii) Environmental degradation and its impact on livelihoods.
(e) Direct and indirect impacts:-
i) "Direct impacts" will include all impacts that are likely to be experienced by the
affected families;
ii) "Indirect impacts" will include all impacts that may be experienced by those not
directly affected by the acquisition of land (i.e. Direct land and livelihood losers),
but those living in the project area.
f) Differential impacts:-
(i) Impact on women, children, the elderly and the different abled ;
(ii) Impacts identified through tools such as Gender Impact Assessment Checklists,
and Vulnerability and Resilience Mapping.
g) Cumulative impacts:-
(i) Measurable and potential impacts of other projects in the area along with the
identified impacts for the project in question.
(ii) Impact on those not directly in the project area but based locally or even
regionally.
119 | P a g e
Form- H
Preliminary Notification
No ______________ Date _____________
Whereas it appears to the Government of Odisha that a total of _____________ acre land,
details of which have been given below, is required to be acquired for _____________ purpose. This
notification is hereby given for information of the general public. Any person interested in any land
which is notified hereunder may, within sixty days from the date of publication of this notification,
object to the area and suitability of land proposed to be acquired, justification offered for public
purpose and the findings of the Social Impact Assessment report to the Collector in writing.
1. Nature of the public purpose:
2. Name of the Requiring Body:
3. Reasons necessitating the displacement of affected persons:
4. Summary of the Social Impact Assessment Report:
5. Particulars of the Administrator appointed for the purposes of rehabilitation and resettlement:
6. Land Details:
Rural / Khata Plot Area to be Name of recorded

District Tahasil Village Total area
Urban No. No. acquired raiyat
(1) (2) (3) (4) (5) (6) (7) (8) (9)
120 | P a g e
No person shall make any transaction or cause any transaction of land specified in this
preliminary notification or create any encumbrance on such land from the date of publication of this
notification without prior approval of the District Collector.
Objections to the acquisition, if any may be filed by the person interested within 60 (sixty)
days from the date of publication of this notification as provided under section 15 of the Right to Fair
Compensation and Transparency in Land Acquisition, Rehabilitation and Resettlement Act, 2013
before the District Collector.
By order of the Governor,
121 | P a g e
Form-I
DECLARATION
No_____________ Date ____________
It is hereby declared for information of all concerned that after consideration of the report of
the Collector submitted in pursuance to provision of sub-section (2) of section 15 of the Right to Fair
Compensation and Transparency in Land Acquisition, Rehabilitation and Resettlement Act, 2013, the
State Government is satisfied that land to an extent of _____________ acres in Village _____________,
PS _____________, District _____________ as scheduled below at "A" is needed for public purpose, as
defined under sub-section (1) of section 2 of the Act i.e. for _____________ Project (Government /
Private / PPP Project) and by _____________. (Name of the project developer and Requiring Body to
be clearly specified).
Preliminary notification under sub-section (1) of section 11 of the Act was published vide
Notification No_____________ dated_____________.
It is further declared that the land to an extent of _____________ acres in village

_____________, PS _____________, District _____________ as scheduled below at "B" has been
identified as the resettlement area for the purpose of rehabilitation and resettlement of the displaced
families.
The summary of the Rehabilitation and Resettlement Scheme applicable to the affected and
displaced families relating to the land covered under this Declaration is attached herewith.
The approved Rehabilitation and Resettlement Scheme is available in the office of the
Collector and Administrator R&R and has also been uploaded on the website of the District
_____________ (website address to be specified) and on the website of State Government ( website
address to be specified ) for public view. A plan of the land may be inspected in the office of the Land
Acquisition Officer/ _____________ on any working day.
122 | P a g e
Schedule-A
(Land under proposed acquisition)
District: Tahasil:
Name of
Name of the Rural / Area to be
Khata no. Plot no. Kissam Total area recorded
Village Urban acquired
raiyat
(1) (2) (3) (4) (5) (6) (7) (8)
Schedule-B
(Land identified as the resettlement area)
District : Tahasil :
Name of Rural/ Khata Plot no. Kissam Total Area selected Name of
the Urban no. area for recorded
Village Rehabilitation raiyat
(1) (2) (3) (4) (5) (6) (7) (8)
Note:- In projects where land is acquired in stages, land covered under declarations in preceding
stages to be specified along with the summary of R&R Scheme and implementation status
relating to those stages.
By order of the Governor

Principal Secretary to Government / Authorised Officer
Revenue and Disaster Management Department.
123 | P a g e
Form- J
Prior written consent form
1. Name of the person(s) in whose name the land is registered:

2. Name of the spouse:
3. Name of father/ mother:
4. Address:
5. Village:
6. Gram Panchayat/Municipality/Township:
7. Tahasil:
8. District:
9. Name of other members in the family with age: (including children and adult dependents)
10. Caste Status (ST/SC/OBC/Others)
11. Extent of land owned:
12. Disputed lands if any:
13. Pattas/leases/grants, if any:
14. Any other right, including tenancy, if any:
15. Regarding acquisition of my land bearing Khata No. ______, Plot No. ______, measuring an area
of Ac. _______, in Village _______ of District ____________ by the government, I wish to state as
follows: -
a) I have *read/*readout the contents of this consent form and the terms and conditions of
compensation, rehabilitation and resettlement benefits and other measures committed by the
Requiring Body.
b) *l do not agree to this acquisition.

c) *l agree to this acquisition.
Signature/Thumb impression of the affected Family(s)
Date:
124 | P a g e
FORM- K
(See rule 29 of the Odisha Right to Fair Compensation and Transparency in

Land Acquisition, Rehabilitation and Resettlement Rules, 2015)
Land Acquisition Award
Land Acquisition case No.:
1 Name of the project-

2 Number and date of declaration under which the land is to be acquired
3 Location and extent of the land in acres, the number of field plots with specification, the
village in which situated
4 Description of the land, i.e. whether fallow, cultivated, homestead, etc. if cultivated, how
cultivated?
5 Names of persons interested in the land and the nature of their respective interests.
6 Amount allowed for the land itself, without trees, buildings etc. if any
7 Amount allowed out of such sum as compensation for the tenants interest in the land
8 Basis of calculation:
9 Amount allowed for trees, houses or any other immovable things.
10 Amount allowed for crops.
11 Additional compensation on the market value under section 30(3) of the Right to Fair
Compensation and Transparency in Land Acquisition, Rehabilitation and Resettlement
Act, 2013) (hereinafter mentioned as the Act).
12 Damages under section 28 of the Act.
13 Solatium u/s 30(1) of the Act.
14 Award under section 23 and 30 of the Act.
15 Particulars of abatement of Government Revenue, or of the capitalized value paid, the date
from which the abatement takes effect.
16 Apportionment of Serial No. Name of Amount Bank A/c Remarks
the amount of claimants payable to No.
compensation each
Area in (Ac.)
17 Date on which
possession was
taken u/s-38(1) and
40(1) of the Act.
If possession has been taken earlier in accordance with the provision under sub section (1) of section
40 of the Act, the number and date of the order of Government giving authority to do so may be
mentioned here.
Date: Signature
125 | P a g e
FORM - L
(See rule 35 of the Odisha Right to Fair Compensation and Transparency

in Land Acquisition, Rehabilitation and Resettlement Rules, 2015)
Award for Rehabilitation and Resettlement
Land Acquisition case No.
1 Name of the project-

2 Number and date of declaration under which the land is to be acquired
3 Location and extent of the land in acres, the number of field plots with speciation, the village in
which situated
4 Description of the housing units, transportation cost, housing allowances, annuity, employment
subsistence grant, cattle shed, petty shop, one time resettlement allowances etc.
5 Name /Names of persons interested in the land and the nature of their respective claim for
rehabilitation and resettlement.
6 Apportionment of Name of R&R Bank Ac. No. Amount Non Re-
the amount of claimants entitle payable monetary mark
compensation /affected ments to each entitlement s
Area (in acres) family s
(a) House to be allotted
(b) Land to be allotted
(c) Fishing rights
(d) Annuity
(e) Employment
(f) Transportation cost,
(g) Housing allowances,
(h) Employment
(i) Subsistence grant
G) Cattle shed,
(k) Petty shop,
(I) One time resettlement
allowances
7 Date on which R&R entitlements given to the affected family.
Date: Signature
126 | P a g e
Form - M
Format for Gram Sabha Resolution
We, the undersigned members of the Gram Sabha of _____________ within _____________
Panchayat of _____________ Tahasil in District _____________ wish to state that the following
certification is based on the information supplied by the administration and officials. If this
information is incomplete or incorrect and/or if any consent has been obtained through any use of
threats, fraud or misrepresentation, it is null and void. On this basis this Gram Sabha hereby certifies
that it "consents / "refuses to consent to the proposed _____________ project, which will involve;
1. acquisition of _____________ acres of private land,

2. transfer of _____________ acres of government land to the project, and
3. transfer of _____________ acres of forest land to the project.
The terms and conditions of compensation, rehabilitation and resettlements benefits and social
impact mitigation measures agreed to by the Requiring Body (state the name) are attached.
The Gram Sabha also states that any consent is subject to all of its residents receiving title to all
of their individual and community rights over forests and forests lands, including their titles for
forest land that they have been cultivating, ownership titles for all forms of minor forest produce that
they use, and titles to protect and manage their community forests. [Note: This will have to be
certified by this Gram Sabha separately.]
Date:
Signatures/ thumb impressions

of Gram Sabha members
Date:
Signature of Designated District Officer

on receipt of the Resolution
By Order of the Governor
127 | P a g e
Odisha Minor Mineral Concession
Form -F
Intimation to Successful Bidder
[See rule 10(11), 16(9), 27(6)]
Letter No.__________________ Dated________________
From
________________________________
________________________________
________________________________
To
________________________________
________________________________
________________________________
Sub: Intimation to successful bidder.
Sir/Madam,
This is to intimate that you have been selected as the successful bidder for the prospecting
license-cum-mining lease/mining lease/ quarry lease (strike off the lease not intended for) described
below, namely:—
________________________________________________________________
________________________________________________________________
________________________________________________________________
(Name of lease, area, period of lease) based on your application for the said lease. The amount
of additional charge bid by you and accepted is Rs._______________ per tonne/cubic metre
(strike off whichever is not applicable).
The mining plan and the environment clearance for the said lease has been obtained/ has not
been obtained (strike-off whichever is not applicable). The tentative selection is subject to the
provisions of the OMMC Rules, 20.......... and to the terms and conditions annexed with this letter.
You are directed to convey your acceptance to the terms and conditions and to deposit an
amount as prescribed under rule 10(12) & (13)/ 16(10) & (11)/ 27(7) & (9) (strike-off whichever is not
applicable). Proof of deposit of the aforesaid amount along with acceptance should reach the
undersigned within fifteen days of the date of issue of this letter failing which this intimation shall
stand automatically revoked without any further notice and the earnest money shall stand forfeited.
You are also directed to execute deed in respect of the prospecting license-cum-mining lease/
mining lease/ quarry lease (strike-off whichever is not applicable) for the aforesaid area within the
period specified in sub-rule (1) of rule 43 of the Odisha Minor Mineral Concession Rules, 20.....
Yours faithfully
___________________
___________________
(Name/ Designation)
(Competent Authority)
128 | P a g e
FORM -H
Intimation of opening/reopening of the mine/quarry
[See rule 12(6), 17(2) & 33(4)]
To
1. (a) The Deputy Director of Mines/ Mining Officer.............. (location).

(b) The Director of Mines, Odisha, Bhubaneswar.
(c) The ................(Secretary) to Government, Department of Steel & Mines, Odisha,
Bhubaneswar.
(d) The Collector.................... (District).
(e) The Director of Mines Safety, Bhubaneswar/ Chainbasa.
2. (i) Name of the mineral :
(ii) Name(s) of other minerals if any, for which lease has been granted :
3. Name of the Mine/Quarry :
4. Name and address of the Lessee /Owner:
5. Ownership of the mine
(a) Public Sector (b) Joint Sector (c) Private Sector
6. Date of Opening /Reopening of Mine/Quarry ...........................
7. In case of Reopening, date of discontinuation......................
8. Particulars of the Mining Lease (ML)/ Quarry Lease (QL):
(i) Date of Execution:
(ii) Period ____________years, from _________To ___________
(iii) Areas under Lease __________ hectares.
9. Location of the Mining Lease /Quarry Lease:
(i) Village _____________ Dist_______________ Tahasil_____________
(ii) Post Office ______________________ P.S._____________ Dist___________
(iii) Nearest Railway Station__________________ Distance_________________
10. Name and address of the Previous Owner, if any, and the date of abandonment:
11. Particulars of Agent: Name and Address:

12. Particulars of Mining Engineer employed in the mines:
(i) Name and Address:
(ii) Qualification:
(iii) Date of Appointment:
(iv) Status of Employment: (Whole time or Part Time)
13 Particulars of the Mines Manager: Name and address:
Certificate of Competency (1st Class/ 2nd Class/ Permit):
14. Letter No. And date through which the mining plan was approved
Letter No………………………Date:
Place: Signature
Date: Name in Full:
Designation: Owner/Agent/Mining
Engineer/Manager
129 | P a g e
Form –M Application for grant of Quarry Lease
To
........................................................................................................
Dated the 20
Sir,
1 I/We submit an application for a quarry lease for..........(mineral) for a term of .............. years
over.........hectares of land in the area specified in the Annexure given below:-
2. A sum of Rs....... payable as fee (Non-refundable) for grant of such lease under sub-rule (4) of
rule 27 of the Odisha Minor Mineral Concession Rules, 20...... has been paid in the Government
Treasury at.........and a receipted challan bearing No....... dated.....is enclosed.
3. The required particulars are given below :-

i) An affidavit stating that no mining due payable under the Act and Rules made there under is
outstanding against the applicant.
ii) Where land belongs to private persons, consent of all such persons for grant of quarry lease.
iii) Solvency certificate and list of immovable property from the Revenue Authority.
4 (i) Name and address of the applicant.....................................

(ii) Nationality of the applicant...........................................
(iii) Profession of the applicant...........................................
(iv) Particulars of the areas, mineral wise, within the State for which the applicant or any person
having joint interest with him................................
a) Already holds a quarry lease....................................
b) Has already applied for a quarry lease but not granted ..................
c) Being applied for simultaneously................................
d) Nature of joint interest, if any..................................
(v) Means by which the minor minerals is/are to be raised, i.e. whether manual or
mechanical.......................
(vi) Manner in which the minor mineral raised to be utilized
(a) For manufacture.........................
(b) For sale.......................................
(c) Any other purpose......................
(vii) Details of the plan boundary description and land schedule of the area applied for to be
enclosed.
(viii) Has the applicant any previous experience in quarrying/mining? If yes, details should be
given.................
(ix) Financial Resources of the applicant.
(a)
(b)
130 | P a g e
(x) Total investment in the operations anticipated.....................
(xi) Any other particulars which the applicant wishes to furnish:
(a) Name of the village/Forest Block
(b) Whether the area belongs to Scheduled Area.
(c) Details of the area applied for in each Survey Number
(d) Full description of the area applied for with regard to nature features
(e) District..................
5. Rate of additional charge (per cubic meter) quoted-
N.B: The application shall be summarily rejected if the rate of additional charge quoted is less than
the rate of additional charge specified in the notification.
I/We hereby declare that the particulars furnished above are correct and undertake to furnish
any other details, plan, etc., as may be required by you.
Yours faithfully,
Place.........
Date.......... Signature of the applicant
N.B: If the application is signed by an authorised agent of the applicant, the power of attorney
should be attached.
131 | P a g e
FORM –N Form of Quarry Lease
THIS INDENTURE made this ............ day of ......20..........between the GOVERNOR OF

ODISHA...................... (herein after called the “Lessor”) of the one part and (Name of person)
..............................of (address and occupation)........... (herein after called the “lessee” which expression
shall where the context so admits be deemed to include his heirs, executors, administrators,
assignees) of the other part.
WHE.................(minor mineral) in accordance with the provisions of the Odisha Minor
Minerals Concession Rules, 20..... in respect of the lands described in Part I of the Schedule and has
deposited a sum of Rs.................as security.
AND WHEREAS the Competent Authority has communicated his approval to the grant of
lease on the terms, covenants and conditions hereinafter contained. NOW THIS INDENTURE
witnesses as follows:
The lessor hereby demises to the lessee the land described in Part I of the Schedule hereunder
written and delineated in the map hereunto annexed.
The said demised pieces of land shall be held by the lessee for a term of .........years from the
date on which this executed deed is registered under Indian Registration Act and Odisha Registration
Manual, subject to the terms, convents, conditions hereinafter provided.
IN WITNESS WHEREOF these presents have been executed in manner hereunder appearing
the day and year first above written.
REASE the lessee has applied to the Competent Authority concerned for a quarry lease for
The schedule above referred to
PART-I
Location and area of the lease
Village Plot Nos.

Village/Forest Block
Tahasil/Forest Range
Area (in hectares)
As per plan annexed and bounded

On the North by
On the South by
On the East by
And on the West by
hereinafter called as “said lands”
132 | P a g e
PART-II
Terms and conditions of the lease

This lease is subject to the conditions laid down in rule 33 and also all other conditions
pertaining to lease as provided in the Rules.
PART-III
Liberties, powers and privileges to be exercised and enjoyed by the Lessee
1 To enter upon and use the land, described in Part I of the Schedule during the term hereby
demised to carry on all operations necessary for extraction, collection, stacking , processing,
transport and disposal of minor mineral/minerals leased in natural or in processed/converted
form.
2 To make roads, tram ways, install machineries, lay eclectic and telephone line, on and over the
said lands.
3 To use water from streams, watercourses and springs in and upon the said lands in natural state
or by means of impounding with the written permission of the Collector of the district.
PART-IV
Restrictions and conditions as to the exercise of liberties, powers and privileges in Part-II
1 No land shall be used for surface operations if objection is raised by the Competent Authority
or the Collector of the district to the effect that use of the land will be detrimental to public
interest.
2 The lessee shall not cut or injure any tree in the leased area falling within Reserved/Protected
forest without prior permission of the Divisional Forest Officer or the officer authorized by him
in this behalf and upon payment of royalty and fees for compensatory afforestation as may be
specified.
3 The lessee shall undertake mining operation only in accordance with approved mining plan or
scheme of mining, as the case may be.
4 The lessee shall not transport or store or cause to be transported or stored any specified minor
mineral for the purpose of selling or trading otherwise than in accordance with these Rules and
as may be specified under Odisha Minerals (Prevention of Theft, Smuggling and Illegal Mining
and Regulation of Possession, Storage, Trading and Transportation) Rules, 2007.
PART-V
Liberties, powers and privileges reserved to the State Government
The State Government or any officer, or persons authorized by it in that behalf has the liberty
and power to enter into and upon the leased area to carry on any operation in connection with
survey, sampling, testing, quarrying, processing, stacking and transportation of mineral as may be
deemed necessary.
PART-VI
Provision regarding Rents and Royalties
133 | P a g e
1 The lessee shall, during the subsistence of this lease pay to Government royalty in respect of the
minor mineral removed by him from the leased area at the rates prescribed in Schedule II and
surface rent at the rate prescribed in Schedule I.
2 All payments relating to rents, royalties, fees, etc., as provided under these rules shall be paid to
the State Government free from all deductions, at the District Treasury/Sub-Treasury and in
such manner as the Competent Authority may prescribe.
3 For the purpose of computing the royalty, the lessee shall keep correct account of the mineral
produced, stacked and removed from the lease area and submit a return to the Competent
Authority and Director in Form K & Form P.
4 The lessee shall pay royalty in advance and the differential amount, if any, on computation
shall be paid by the end of the first fortnight of each half yearly period during the subsistence of
the lease.
5. The lessee shall pay surface rent in advance and not later than 15th January and 15th July of
each year.
Signed by....................
For and on behalf of Governor of Odisha, in the presence of
1.
2.
Signed by ................................Lessee in the presence of

1
2
134 | P a g e
FORM -O
Preparation of Mining Plan for Quarry Lease by RQP
[See rule 28(4)]
MINING PLAN FOR WINNING OF _________________ (RIVER SAND/LATERITE
SLABS/MORRUM/ORIDINARY/ROADMETAL etc.) FROM_____________ (NAME OF THE
VILLAGE/FOREST etc.) UNDER __________ PANCHAYAT, TAHASIL OF ________
DISTRICT.
[CATEGORY :____________( B1/B2)
As specified by MoEF vide Notification
No. J-13012/12/2013-IA-II (I) dated 24.12.2013]
1 Name & Address of the lessee:

2 Particulars of the Area (Acreage, Boundary Description & Land Schedule): (Attach location map
and surface plan showing the existing features of the area with contours at 2m interval):
3 Status of the Lessee: (Private Individual/ Private Company/Public Sector Undertaking/ Joint
Sector Undertaking / Others):
4 Period of the concession : (from____ to_____)
5 Mineral intended to be won :
6 Name, Address & Registration No. of RQP preparing the mining plan with validity of
recognition:
7 Order No. & date of Competent Authority granting the concession : (copy of the order to be
attached) :
8 If, forest area, whether forest clearance obtained: (Attached copy of forest clearance)::
9. Reserves :
(Estimation to be based on the exploration, if any, carried out in the area or on the local
parameters)
10. Mining :
(a) Whether manual or semi-mechanized or mechanized :
(b) If semi-mechanized, number, type and capacity
of machines to be used :
(c) Whether drilling and blasting will be made use of ,
if yes, state monthly quantity of explosives
to be consumed :
(d) Benching pattern (Height x Width) :
(e) Face lay out (attached development plan) :
(f) Quarry Floor level (RL) at the end of each year
and at the end of period of the concession :
(g) Quantity of mineral to be won
(Annual Level of Production) :
135 | P a g e
(h) Quantity of overburden to be removed
(Show location of such disposal in development plan :
(i) Whether heavy blasting to be adopted if yes,
location of nearest habitation
(to be shown in the surface plan) :
(j) Safety precautions to be adopted :
(k) Brief description on method of procurement
and storage of explosive :
11. Waste Disposal :

(a) Location (show it in the development plan)
(b) Area covered :
(c) Environment safeguards for such disposal :
12. Mine Drainage:

(Give details of total make of water during dry and rainy
season and its method of handling) :
13. Mineral Processing :
(Give details processing including sizing, sorting, generation
of Reject/fines etc. :
14. (a) No. of tress to be uprooted due to mining operation :
(b) Programme of Plantation :
15. Manpower : :
(a) Supervisory : (inclusive of statutory personnel) :
(b) Non-Supervisory (skilled, semi-skilled & unskilled) :
(c) OMS :
16. Use of Mineral:
(Specification and monthly quantity to be dispatched to be furnished):
(a) For domestic use :
(b) For export :
17. Mine Closure Plan:

(a) Describe the process/activities to be undertaken
for reclamation and rehabilitation in respect
of the following :
i) Mined out land :
ii) Waste/reject dump :
iii) Top-soil stack and its utilization :
(b) Financial Assurance :
136 | P a g e
(To be furnished as a bank guarantee in
respect of the area to be put to use at the rate
of Rs. ________ per hectare) :
18. Certificate
I/We, the holder of ___________________ (type of concession) for _____________ (mineral)

over ____________ hects., in ________________________ (village/forest) under ____________
Panchayat, ______________ Tahasil of __________District hereby solemnly affirm that the plans and
programmes in this mining plan will be scrupulously implemented by me/us and I/we will be
strictly held responsible for any deviation thereof, I/We also hereby certify that the provisions of
Mines and Minerals (Development & Regulation) Act, 1957, and the Mines Act, 1952 and Rules and
Regulations made under these Acts, along with the provisions of Odisha Minor Mineral Concession
Rules, 20... will be strictly adhered to while implementing this mining plan and wherever specific
permissions will be required, I/We will approach the concerned authorities of Directorate General of
Mines Safety and the State Government, as the case may be.
(Signature of the Concessionaire)
137 | P a g e
FORM -P
Quarterly return of Minor minerals other than specified minor minerals
[See rule 33(15)]
For the quarter ending................20.....
1 Name of the mineral:

2 Name and location of the Quarry:
Name of the Quarry:
Village:
Post office:
Tahasil:
District:
3 Name and address of lessee/Quarry owner:
Name:
Address:
4 Lease details:
Area in hectares: Date of Execution:
Period (Years): Date of starting quarrying Operations:
5 Number of days the quarry worked during the quarterly period:
6. Indicate reason(s) for work stoppage:
Number of days:
Reasons: (i)
(ii)
7. Production, despatches, Stocks and Pit’s mouth value (Unit: tonne/cubic meter):
Items Total in the quarter

Opening Stock
Production
Despatches
Closing Stock
Pit’s Mouth Value (Rs.)
8 Quantity of waste and rejects generated, if any, (Unit: cubic meter)

9 Quantity consumed in the quarry lease area, if any. (Unit: cubic meter)
138 | P a g e
10 Particulars of machineries equipments used:
11 Particulars of explosives used, if any
12 Average number of persons employed daily:
Male: Female: Total:
13 Rents and royalty paid (Rs.):
14 Dimension of the quarry (in meter)
Length: Width: Depth (Maximum):
15 Any other information:
I certify that the information furnished above is correct and complete in all respects.
Place: Signature
Date: Name (in full):
Designation-
Owner/Agent/Manager
Note: The return shall be furnished by the 15th of the month succeeding the quarter.
139 | P a g e
FORM -Q
Application for Quarry Permit
[See rule 34]
Dated the ............... 20............
To
............................................................
Sir,
1 I/We submit an application for quarry permit for.............. (mineral) a term of ................... months
over..............hectares of land in the area specified in item 3(viii) below.
2 A sum of Rs........ (rupees .............. only) (non-refundable) payable as fee for grant of such permit
under rule 34 of OMMC Rule, 20.... has been paid in the Government Treasury at..........................
and the receipted challan is enclosed.
3. The required particulars are given below.

(i) Name and address of the applicant:
(ii) Nationality of the applicant:
(iii) Profession of the applicant:
(iv) Quantity of minor mineral required to be extracted and removed (in tonnes/ cubic
metres):
(v) Minor mineral is to be raised manually or mechanically:
(vi) Manner in which the minor mineral raised is to be utilised:
(vii) Particulars of the receipted treasury challan for the fee :
(viii) Plan in 16”=1 mile scale (Cadastral village map) and Land Schedule of the area from
which the minor mineral are to be extracted and removed is to be enclosed :
(ix) If the land applied for belongs to private land owners, written consent of the owners
permitting diversion of his land for extraction of minor mineral under quarry permit to be
enclosed :
(x) An undertaking by the applicant that he agrees to abide by the conditions governing
extraction and removal of minor mineral under a quarry permit to be enclosed :
(xi) Any other particulars which the applicant wishes to furnish:
I/We hereby declare that the particulars furnished above are correct and undertake to furnish
any other details, plan etc., as may be required by you.
Place: Yours faithfully,

Date:
N.B. - If the application is signed by an authorized agent of the applicant, the power-of- attorney
should be attached.
140 | P a g e
FORM -R
Grant of Quarry Permit
[See rule 35(1)]
Quarry Permit No................................

Date....................................................
Whereas, Shri.......................... applied for grant of quarry permit for extraction and removal of
...........tonne/cubic metre of ................(minor mineral) from Plot No................of
.......................Village/Forest Division under rule 34 of the Odisha Minor Mineral Concession Rules,
20..... and has paid an application fee of Rs................. , permission is hereby granted to quarry, collect
and remove...........tonne/cubic metre of ............(mineral) from the aforesaid area or areas indicated on
the plan annexed hereto on the following condition and on payment of advance royalty amounting to
Rs ...................calculated at the rate of Rs...........................per tonne/cubic metre (as specified in
Schedule I to the Odisha Minor Mineral Concession Rules, 20.....
(1) The permit shall be valid for............... months/days from..........to..............
(2) The permit holdersshall abide by the conditions provided in rule 37 of the Odisha Minor
Minerals Concession Rules, 20.....
Signature of the Competent Authority/authorized officer.
To
Shri....................
Copy to-
The Director of Mines, Odisha, Bhubaneswar
The Collector...................district,
The Divisional Forest Officer......................
141 | P a g e
FORM -S
Particulars of Quarry Permit
[See rule 37(4)]
1 Quarry Permit No. Date:

2 Name of the Permit Holder(s) with address:
3 Name of mineral:
4. Quantity of mineral permitted for extraction and removal in cubic meter/tonne:
(a) Permitted Quantity: (b) Removed Quantity:
5 Period of validity of the permit: Form dt.: To dt.:
6 Production of mineral in cubic meter/tonne:
7 Despatch of mineral in cubic meter/tonne:
8 Royalty and Surface Rent due for payment (in Rs.):
9 Details of payment of royalty with treasury challan No. and date:
10 Number of man-days worked for production:
11 Pit’s Mouth Value (Rs. Per cum/tonne.):
12 Sale Price at quarry site (Rs. Per cum/tonne.):
13 Date of surrender of the permit to the Competent Authority:
I/We declare that the above information are correct.
Place: Signature of the permit holder

Date:
Note- The particulars shall be furnished to the Competent Authority and authorized officer on his
behalf.
142 | P a g e
FORM -T
Register of Quarry Permit
[See rule 38]
Name and No. and

Sl. address of Date of date of Mineral/ S.No. / Village/Forest
Tahasil
No. Permit application order of Minerals S.Nos. Ranges
Holder grant
(1) (2) (3) (4) (5) (6) (7) (8)
Quantity Whether
Details of Date of removed all dues
Signature
Quantity Permitted royalty expiry of under the have Remarks
of officer
received Permit Permit been
recovered
(9) (10) (11) (12) (13) (14) (15)
143 | P a g e
FORM -V
Register of Mining Lease
[See Rule 43(5)]
Sl.No. Name Date of No. and Date of Date of Period Mineral/

and application date of Execution registration of lease Minerals
address grant
of the order
lessee
(1) (2) (3) (4) (5) (6) (7) (8)
Details
Date of Date of
Tahasil/ Details of
Village/ Area commence expiry/Sur Transfer of
Sub- of refund Signature
Forest in ment of render/ Mining Remark
division/ security of of Officer
Range Hects. mining Determination Lease
District deposit security
operations of lease
Deposit
Name
and
address
Date
of the
transfer
ee
(9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19)
144 | P a g e
FORM -W
Register of Quarry lease
[See rule 43(5)]
No. and Date of Village/

Sl. Name and Date of Date of Period Mineral/
date of registrati Forest
No. address application execution of lease Minerals
grant order on Ranges
(1) (2) (3) (4) (5) (6) (7) (8) (9)
Detail Date of Date of Transfer of Details

of commencement expiry/ Quarry Lease of
Tahasil/
Area security of quarrying surrender/ Date Name refund Signature
Sub-
in deposit operation determination and of of Remarks
divisions/
Hects. of lease address Security Officer
District
of the Deposit
transferee
(10) (11) (12) (13) (14) (15) (16) (17) (18) (19)
145 | P a g e
FORM -X
Form of Appeal
[See rule 46(1)]
(To be submitted in triplicate)
1 Name and address of the individual /firm/company ..............................

2. (a) Full details of the order and the authority passing the order against which the appeal or
revision application is made (certified copy to be enclosed) .........................
(b) Date of communication of the above order:
3 Minerals/Minerals forming the subject matter of the appeal......................
4 Details of the area in respect of which the appeal is filed (A plan of the area to be attached).
Sl. Tahasil/Forest Village/Forest
District/ Forest Division
No. Range Block
5 Is the appeal filed within one month of the date of the order of the Competent
Authority/Controlling Authority?
6 If not, the reasons for not presenting it within the prescribed time.
7. (a) Name and complete address of the party/parties impleaded.
(b) Reasons for impleading him/ them shall be mentioned.
(c) An additional copy of the appeal application for each impleaded party is to be submitted.
8. Has the applicant deposited the amount, if any, assessed in accordance with provisions of
Odisha Minor Mineral Concession Rules, 20....as per the orders appealed ?If so, the details
thereon.
9. If the application is signed by an authorized agent of the applicant, an attested copy of power of
attorney shall be attached.
10. Whether application fee of rupees one thousand has been deposited ? If so, original receipted
challan no ............ dated .................of the State Bank of India/ Treasury ..............is enclosed.
Place:
Date: Signature and designation of the applicant
146 | P a g e
FORM -Y
Transit Pass for Minor Minerals
[See rule 58(1)]
Book No............................ Pass No.............
Date...................
Name of the Mining Lease/ Quarry Lease..................

Name of the licensee-cum-lessee /lessee/ Permit
Holder..................................................................................................
Destination........................Route...........................
Minor Mineral
Quantity Permitted (Cum /Tonne)
Measurement of Mineral in
The Carrier Length (m) Breadth(m) Height(m)
Cubic Content (Cum.)
Weight of the Vehicle (Tonne) Gross Tare
Weight of Mineral (Tonne)
Signature of the person Signature of the carrier
Signature of the Issuing with date driver with date checking staff with date
Signature of the person Signature of the supervising

Receiving with date officer/Competent Authority
With date Office Seal
147 | P a g e
FORM -Z
Annual return by the Competent Authority and Deputy Director or Mining Officer
For the year 1st April 20....to 31st March, 20....
District:
Sub-Division:
Tahasil:
Forest Division:
Mining Circle:
(For each revenue district separate forms shall be used)
Name of minor minerals (Use one column for each mineral)

Sl. Specified Sand Laterite
Item
No. minor
minerals
(1) (2) (3) (4) (5) (6) (7) (8)
1. No. of grant of
(a) Mining Leases
(b) Quarry Leases
(c) Quarry permit
2. No. of subsisting
(a) Mining Leases
(b) Quarry Leases
(c) Quarry permit
3. Production (cum/tonne)
(a) Mining Leases
(b) Quarry Leases
(c) Quarry permit
Total
148 | P a g e
Orissa Public Demands Recovery
Form No. 13
ORDER ON THE NAZIR FOR CAUSING PUBLICATION OF
PROCLAMATION OF SALE
(See Rule 25)
To
The Nazir of...........
Whereas an order has been made for the sale of the property of the certificate-debtor under
Certificate No.......... dated the.........., 19......... which is specified in the Schedule hereunder annexed
and whereas the .......day of........ 19......, has been fixed for the sale of the said property,......... copies of
the proclamation of sale are by this warrant made over to you and you are hereby ordered to have the
proclamation published by beat of drum within each of the properties specified in the said Schedule
to affix a copy of the said proclamation on a conspicuous part of each of the said properties and
afterwards on my office and then to submit to me a report showing the dates on which and the
manner in which the proclamations have been published.
Dated this .......... day of........... 20..........
Certificate Officer
_____________________
149 | P a g e
Form No. 14
CERTIFICATE BY OFFICER HOLDING A SALE OF THE

DEFICIENCY OF PRICE ON A RE-SALE OF PROPERTY BY
REASON OF THE PURCHASER'S DEFAULT
(See Rule 29)
Certified that the re-sale of the property in execution of Certificate No........ dated the..............
19.............., in consequence of default on the part of ........purchaser, there was........ deficiency in the
price of the said property amounting to Rs............ and that the expenses attending such re-sale
amounted to Rs........... making a total of Rs.......... ,which sum is recoverable from the defaulters.
Dated this.............. day of.......... 20............
Officer Holding the sale
150 | P a g e
Form No. 15
CERTIFICATE OF SALE OF LAND

(See Rule 50)
This is to certify that .....................................................has been declared the purchaser at a sale
by public auction on the...... day of ...........20 ............,of...... in the execution of .............. Certificate
No.........., dated the ...........20............., and that the said sale has been duly confirmed by me.
Given under my hand and seal, this..............day of..........., 20.........
Certificate Officer
151 | P a g e
Form No. 16
ORDER FOR DELIVERY TO CERTIFIED PURCHASER OF LAND

AT A SALE IN EXECUTION
(See Rule 51)
To
The ............
Whereas............has become the certified purchaser of ................ at a sale in execution of

Certificate No........ dated the ............20......, you are hereby ordered to put the said.........., the certified
purchaser as aforesaid into possession of the same.
Given under my hand and seal, this........., day of ............., 20.......
Certificate Officer
152 | P a g e
Form No. 17
REGISTER OF CERTIFICATE
(See Rule 54)
Board’s Register No. 10................... Certificates made under the Orissa Public Demands Recovery Act,
1962.
NOTE 1. If separate volumes of the register are kept for local cess, wards, etc., it will not be
necessary to describe the nature of the claim in column 5 as “Local Cess for the Kist of
etc.” but it will suffice merely to mention the particular Kist or instalment. In the
volume for miscellaneous cases, however, the particular department should be
mentioned in this column.
NOTE 2. Process fees or costs under sections 54 and 55 of the Orissa Public Demands Recovery
Act, 1962, should be shown separately in sub-column (a) of column 13.
NOTE 3. Delay due to appeals should be noted in column 15.
NOTE 4. Certificates received on transfer from other districts are to be shown in red ink.
NOTE 5. Every amendment of a certificate and every payment made on it will be noted in this
register under the initials of the Certificate Officer.
NOTE 6. Column 6-A is only to be used for cases of wards and encumbered, etc., states.
Serial Serial number Date of Name and Nature Amount Amount Date of Section of
number of requisition in receipt by address of of of Claim with date certificate Act under
of the Register 9, or Certificate debtor Claim of court or which
year name of other Officer process certificate
district from fees is made
which received
1 2 3 4 5 6 6 (a) 7 8
153 | P a g e
Petitions under section Amou Amoun Notice under Realisations Entry of Re-
8 nt of t of section 6 and satisfacti mar
claim claim subsequent on by ks
decree with process Certifica
d on costs, if te
(a) (b) (c) (a) (b) (a) (b) (c)
objecti any Officer
Date Date of Date on under Date Kind of Amoun Numb Dat
of hearing of with order of process i.e., ts er of e
Recei by dispos costs, if of Issu whether Chala
pt Certific al or any Appell e notice n
ate return allowe ate under
Officer d Court section 6 or
or under 16 or
submiss section warrant of
- ion to 10 attachment,
Requiri etc.
ng
Officer
9 10 11 12 13 14 15
______________
154 | P a g e
Form No. 18
[See Section 16(1)]
NOTICE TO PAY TO THE CERTIFICATE OFFICER MONEY

BECOMING DUE TO OR BEING HELD BY ANY PERSON/
AUTHORITY TOWARDS SATISFACTION OF CERTIFICATE DUES
To
..................................................................
Whereas ...................................................................... certificate-debtor in certificate Case

No................................ of ............................... has to pay certificate dues amounting to Rs.............................
.
And whereas it has come to the knowledge of this Court that a sum of Rs.............. appertaining
to the said certificate-debtor is being held by/becoming due to you.
You are hereby required to withhold a sum of Rs........................ out of the dues aforesaid and
remit the said sum to this Court by ....................... forth with when it becomes due for payment to the
certificate-debtor.
Given under my hand and seal, this .........................day of .......................20..........
Certificate Officer
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*[Form No. 19]
ATTACHMENT IN EXECUTION
Prohibitory order, where the property consists of immovable property
(See Rule 22)
District
In the Court of .........................................................at................................
To
CERTIFICATE-DEBTOR
Whereas you have failed to satisfy
Certificate No.......... of.......... 20...... for Rs.............. it is ordered that you, the said .......... be and
you are hereby prohibited and restrained, until the further order of this Court, from transferring or
charging the property specified in the Schedule hereunto annexed, by sale, gift, or otherwise, and all
persons be, and that they are hereby, prohibited from receiving the same by purchase, gift or
otherwise.
Given under my hand and the seal of the Court, this day of............20......
(Seal) SCHEDULE
Certificate Officer
156 | P a g e
APPENDIX
FORMS
(See Rule 59)
FORM No.1
CERTIFICATE OF PUBLIC DEMAND
(See Sections 3 & 5)
Filed in the Office of Certificate Officer of ....(name of district)
Further particulars of the public

section 4, sub-section (2),if any]
[Including interest, if any, and
including the fee paid under
signed and period for which

Amount of public demand
for which this certificate is
demand for which this

such demand is due.
certificate signed
Name and Name and Name and
Number of
address of address of address of
certificate
certificate-holder certificate-debtor sureties
1 2 3 4 5 6
I hereby certify that the above mentioned sum of Rs. ............ is due to the abovenamed
.................... from............. the above named.
(If the certificate is signed on requisition sent under Section 4, add)-
I further certify that the above mentioned sum of Rs. ............. is justly recoverable and that its
recovery by suit is not barred by law.
Dated this ............. day of ...........20
A.B.
Certificate Officer of...
157 | P a g e
Form No.2
REQUISITION FOR CERTIFICATE
(See Section 4)
To
The Certificate Officer of the district of .....................
Amount of Nature of the

Name of Address of public demand public demand
Address of
certificate- certificate- Name of surety for which this for which this
surety
debtor debtor requisition is requisition is
made made
1 2 3 4 5 6
I request to recover the above-mentioned sum of Rs. ..............which I am satisfied, after

enquiry, is due from the said ................ in respect of.........
Verified by me on the ............ day of .............. 20
A.B.
(Designation)
158 | P a g e
Form No.3
NOTICE TO CERTIFICATE-DEBTOR
(See Section 6)
To
(Name of certificate-debtor)
You are hereby informed that a certificate against you for Rs...... due from you on account of
........ has this day been filed in my office, under section ...... of the Orissa Public Demands Recovery
Act, 1962. If you deny your liability to pay the said sum of Rs........ you may, within thirty days from
the service of this notice, file in my office a petition denying liability, in whole or in part, on one or
more of the grounds specified below :-
(a) The certificate dues have been fully or partly paid.
(b) The person on whom such notice has been served is not the person named as certificate-
debtor in the certificate.
(c) A certificate-debtor in respect of dues other than those in relation to which the liability
under any law for the time being in force is not open to question in a Civil Court, may
also deny his liability on any other ground.
If within the said thirty days, you fail to file such a petition or if you fail to show cause or do
not show sufficient cause, why such certificate should not be executed, it will be executed, under the
provisions of the said Act, unless you pay Rs........(Rs...... on account of the demand and Rs......on
account of costs of realisation) into my office. *[Until the said amount is so paid you are hereby
prohibited from making any private transfer of delivery of any of your immovable property situated
in this district or in the case of a revenue-paying estate, borne on the revenue-roll of the district, or of
any interest in any such property and should you make any such transaction, it shall be void against
any claim enforceable in execution of this certificate]. If you, in the meantime conceal, remove or
dispose of any part of your movable property, the certificate will be executed immediately.
A copy of the certificate above-mentioned is hereto annexed.
You may remit the amount by money-order, quoting the number and year of the certificate.
Dated this ......... day of ........20...
A.B.
Certificate Officer of .............
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Form No.4
PETITION DENYING LIABILITY
[See Section 8]
To
The Certificate Officer
The humble petition of (name of petitioner) of (address)
SHEWETH-
That a certificate No........ of (year), for the sum of Rs........... has been filed against your
petitioner in your office under section ........, .of the Orissa Public Demands Recovery Act, 1962.
That your petitioner respectfully denies his liability to pay the said sum of Rs........ (or, where
the liability to pay part is admitted, denies his liability to pay more than Rs.........), and this for the
following reasons :-
That the facts above stated are true to the best of your petitioner’s knowledge and belief.
Your petitioner therefore respectfully prays that the said certificate may be set aside (or
modified or varied).
A.B.
(Petitioner)
________________
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Form No.5
NOTICE TO SHOW CAUSE WHY SALE SHOULD NOT BE SET ASIDE
(See Section 28)

To
...............................
Whereas the under-mentioned property was sold on the day of ......19.....in execution of
certificate No........, dated the........19.... and whereas the certificate-holder (or certificate-debtor) has
applied to me to set aside the sale of the said property on ground that........
Take notice that if you have any cause to show why the said application should not be
granted, you should appear with your proof in this office on the day of .......20......., when the said
application will be heard and determined.
Given under my hand and seal, this the day of .........20..........
Description of property-
Certificate Officer
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Form No.6
WARRANT OF ARREST
(See Section 37)
To
....................................
Whereas a Certificate No ........was filed in this office on the ........20....., under section.......... of
the Orissa Public Demands Recovery Act, 1962 against certificate - debtor and the sum of Rs...... as
noted in the margin is due from him in respect of the said
Rs. nP.
certificate and whereas the said sum of Rs...... has not been
paid to the certificate- holder in satisfaction of the said
Original demand : certificate, these are to command you to arrest the said
certificate- debtor and unless the said certificate-debtor
Interest : should pay to you the said sum of Rs. ...... together with Rs.
......for the cost of executing this process or should produce
Costs :
a receipt showing payment of the amount to the Certificate
Execution : Officer to bring him before the Court with all convenient
speed.
_______________ You are further commanded to return this warrant
Total on or before the day of ........20........., with an endorsement
_______________ certifying the day on which and the manner in which it has
been executed or the reason why it has not been executed.
Dated this ...........day of ............, 20..........
Certificate Officer
162 | P a g e
Form No.7
ORDER COMMITTING CERTIFICATE-DEBTOR TO THE CIVIL PRISON
(See Section 37)
To
Whereas.............., who has been brought before me this day .........of 20............, under a warrant
in execution of Certificate No........ filed in this office on the ..........20.........., under section.........of the
Orissa Public Demands Recovery Act, 1962 and by which certificate it was ordered that the said......
should pay........ and whereas the said....... has not paid the said sum nor satisfied me that he is
entitled to be discharged from custody.
You are hereby in the name of Government commanded and required to take and receive the
said into the civil prison and keep him imprisoned therein for a period not exceeding.........., or until
the said certificate shall be fully satisfied or the said shall be otherwise entitled to be released
according to the terms and provisions of section 39 or section 40 of the said Act, and is hereby fix......
np. per diem as the rate or the monthly allowance for the subsistence of the said ........... during his
confinement under this order of committal.
Dated this ..........day of ..............20........,
Certificate Officer
163 | P a g e
Form No.8
NOTICE TO LEGAL REPRESENTATIVE OF CERTIFICATE-DEBTOR

(See Section 51)
To
(Name of Legal Representative)
You are hereby informed that a certificate against........, deceased for Rs...... due from him on
account of.......... was filed in this office on the ........20......, under section.......... of the Orissa Public
Demands Recovery Act, 1962 and that a demand of Rs.......... in respect of the said certificate
proceeding is due from you as the legal representative of the said.......... deceased. If you deny your
liability to pay the said sum of Rs........, you may within thirty days from the service of this notice, file
in my office a petition denying liability in whole or in part. If within the said thirty days you fail to
file such a petition, or if you fail to show cause/do not show sufficient cause why such certificate
should not be executed, it will be executed under the provisions of the said Act, unless you pay Rs.
(Rs.......... on account of the demand and Rs............ on account of costs of realisation) into my office.
Until the said amount is so paid you are hereby prohibited from alienating your immovable property,
or any part of it by sale, gift, mortgage or otherwise. If you in the meantime conceal, remove or
dispose of any part of your movable property the certificate will be executed immediately.
A copy of the certificate above mentioned is hereto annexed.
You may remit the amount by money-order quoting the number and year of the certificate.
Dated this........... day of........, 20..............
Certificate Officer
__________________
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Form No. 9
NOTICE TO CERTIFICATE-HOLDER
(See Section 20)
Whereas.......... has made application to the Court for the removal of attachment on..........
placed at your instance in execution of certificate No....... of 20.........., this is to give you notice to
appear before me on the ........day of ..........20..........., either in person or by a pleader duly instructed to
support your claim as attaching creditor.
Given under my hand and seal, this ..........day of.........20........... .
Certificate Officer
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Form No. 10
WARRANT OF SALE OF PROPERTY
(See Rule 24)
To
The.............
These are to command you to sell by auction after giving....... day’s previous notice by affixing
the same in this office and after making due proclamation, the under mentioned property attached in
execution of certificate No.......... in favour of......, or so much of the said property as shall realise the
sum of Rs............, being the ........ of the said certificate and costs still remaining unsatisfied.
You are further commanded to return this warrant on or before the ....... day of........, 20.........,
with an endorsement certifying the manner in which it has been executed or the reason why it has not
been executed.
Given under my hand and seal, this........day of........20........
Specification of property:-
Certificate Officer
_________________
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Form No. 11
NOTICE OF THE DAY FIXED FOR SETTLING A SALE PROCLAMATION
(See Rule 25)
To
............. Certificate-debtor
Whereas in execution of certificate No...... of a sale is about to be held of your property

mentioned below, you are hereby informed that the day of......., 20......., has been fixed for settling the
terms of the proclamation of sale.
The total amount due from you in respect of the certificate including cost and interests
is............
Given under my hand and seal, this .........day of ........20.............
Specification of property: -
Certificate Officer
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Form No. 12
PROCLAMATION OF SALE
(See Rule 25)
Notice is hereby given that, under rule 24 in Schedule II to the Orissa Public Demands
Recovery Act, 1962 an order has been passed by me for
(1) Certificate No..... of
the sale of the property mentioned in the annexed
19...., under which
Schedule, in satisfaction of the claim of the certificate-
is the certificate
holder under the certificate mentioned in the margin (1)
holder and is the amounting with costs and interest up to date of sale, to
certificate-debtor. the sum of..........
The sale will be by public auction and the

property will be put up for sale in the lots specified in the Schedule. The sale will be of the property of
the certificate-debtor above-named as mentioned in this Schedule below.
In the absence of any order of postponement, the sale will be held by...... at the monthly sale
commencing at ....O'clock on the ......at...... In the event however, of the debt above specified and of the
cost of the sale, being rendered or paid before the knocking down of any lot, the sale will be stopped.
At the sale the public generally are invited to bid, either personally or by duly authorised
agent. The following are the further conditions of Sale.
Conditions of sale
The particulars specified In the Schedule below have been stated to the best of the information
of the Certificate Officer, but the Certificate Officer will not be answerable for any error, misstatement
or omission in this proclamation.
2. The amount by which the bidding are to be increased shall be determined by the officer
conducting the sale. In the event of any dispute arising as to the amount bid or as to the bidder, the
lot shall at once be again put up to auction.
3. The highest bidder shall be declared to be the purchaser of any lot, provided always that he
is legally qualified to bid and provided that it shall be in the discretion of the officer holding the sale
to decline acceptance of the highest bid when the price offered appears so clearly inadequate as to
make it advisable to do so.
4. For reasons recorded it shall be in the discretion of the officer conducting the sale to adjourn
it, subject always to the provisions of rule 28 in Schedule II to the Orissa Public Demands Recovery
Act, 1962.
5. In the case of movable property, the price of each lot shall be paid at the time of sale or as
soon after as the officer holding the sale directs and in default of payment the property shall
forthwith be again put up and resold.
168 | P a g e
6. In the case of immovable property the person declared to be the purchaser shall pay
immediately after such declaration a deposit of 25 per cent on the amount of his purchase money to
the officer conducting the sale and in default of such deposit the property shall forthwith be put up
again and resold.
7. The full amount of the purchase money shall be paid by the purchaser before the office of
the Certificate Officer closes on the fifteenth day after the sale of the property exclusive of such day or
if the fifteenth day be a Sunday or other holiday, then on the first office day after the fifteenth day.
8. In default of payment of the balance of purchase money within the period allowed the
property shall be resold after the issue of a fresh notification of sale. The deposit after defraying the
expense of the sale may if the Certificate Officer thinks fit be forfeited to the Government and the
defaulting purchaser shall forfeit all claims to the property or to any part of the sum for which it may
be subsequently sold.
Given under my hand and seal, this.......... day of.......... 20.......... .
Certificate Officer
SCHEDULE OF PROPERTY
Number of lot Description of The revenue Claims (if any)

property to be sold assessed upon the which have been
with the name of estate or part of the put forward to the
each owner where estate, if the property and any
there are more property to be sold other known
certificate-debtors is an interest in an particulars bearing
than one estate or a part of an on its nature and
estate paying value
revenue to the
Government
1 2 3 4
169 | P a g e
OGFR
FORM O. G. F. R. 2
(See Rule 63)
To
The
(Secretary of Administrative Department/ Heads of the Departments of Heads of offices

of the Relieving and Receiving Offices).
Sir,
In pursuance of Order No …………….., dated …………………… I/We have this day

………………………. in the forenoon/ afternoon relinquished/ made over and taken over charge of
the Office of the ……………………………………………………………… in the Department/ District.
Yours faithfully,
Signature
(Relieved Officer)
Place
Date Signature
(Relieving Officer)
ADDITIONAL INFORMATION TO BE FURNISHED IN RESPECT OF TAKING OVER CHARGE OF

GOVERNMENT MONEY.
I, (Relieving Officer) acknowledge to have received Rs……………………….. (in words Rupees

………………………………………………….) of permanent advance and Rs………………….. (in words
Rupees ………………………………………………….) of other cash and the full amount of such
advance / cash is due from and to be accounted for by me.
Place Signature
Date (Relieving Officer)
Designation
170 | P a g e
Additional information to be furnished regarding leave etc.
(i) By Relieved Officer-
1. If proceeding on leave-
(a) Address during leave
(b) Place at which leave salary is to be drawn.
(If at a Treasury outside the State, a copy of the Last Pay Certificate should be furnished to the
Accountant-General.)
2. If on transfer -
The post and station to which transferred
3. If not proceeding on leave or transfer, reasons for relinquishment of charge.
Signature …………….. (Relieved Officer)

Date…………………...
(ii) By Relieving Officer-
1. If returning from leave.
2. If on transfer form a post- post from which transferred.
3. If not returning from leave or another post, reasons for taking over charge.
Signature ……………..(Relieving Officer)

Date…………………...
Copy forwarded to reliving Officer.

(F.D.O.M. No. Codes-5/80- 29593/F., dated 5-8-1981)
171 | P a g e
FORM O. G. F. R. 3
(See Rule - 67)
Form of Application for leave
1. Name of applicant
2. Leave rules applicable
3. Post held
4. Department/ Office.
5. Pay
6. House-rent allowance, conveyance allowance or other compensatory allowance drawn in the

present post.
7. Nature and period of leave applied for and the date from which leave is required.
8. Grounds for leave
9. Date of return from the last leave and period of that leave.
Place ……………………. Signature of the applicant
Date …………………
172 | P a g e
FOR USE IN OFFICE
1. Statement of leave granted to the applicant prior to this application.
Nature of leave In the current year During the previous year Total
(i) Earned leave.

(ii) Half-pay leave.
(iii) Special disability leave/
study leave/ maternity
leave.
(iv) Extraordinary leave
Total
2. Certified that Sri ……………………………………………………… (Designation

………………………………………………………….) has the following leave at his credit on
………………………………………. .
Earned leave-
Half-pay leave-
3. Order- Recommendation.
Date ………………….
Signature of the Head of Office
(F.D.O.M. No. Codes-5/80- 29593/F., dated 5th August 1981)
173 | P a g e
APPLICATION FOR WITHDRAWAL FROM GENERAL PROVIDENT FUND
1. Name of the Subscriber :
2. Account No. (With Departmental Suffix) :
3. Designation :
4. Pay : G.P. :
5. Date of joining in service

and Date of superannuation :
6. Balance at credit of the subscriber on the date

of application as detailed below :
i) Closing balance as per statement for the year 200 :
ii) Credit from to on

account of monthly subscription.
iii) Withdrawal during the period from :
iv) Refunds made to the fund after the

closing balance vide (i) above. :
v) Net balance at the credit on the date

of application :
vii) Whether final payment application has been

submitted (In case of subscriber who are due
to retire within one year.)
7. Amount of withdrawal required.
(a) Purpose for which the withdrawal is required :
(b) Rule under which the request is covered : Rule 30, Note - 2 read with
Appendix 'F' of GPF (O) Rules.
8. Whether any withdrawal was taken for the

same purpose earlier, if so, indicate the
amount and the year. :
9. Name of the Accounts Officer maintaining : Accountant General (A&E),

the Provident Funds Account. Odisha, Bhubaneswar.
Name :
Designation
174 | P a g e
Sanction of Deputation
GOVERNMENT OF ODISHA
REVENUE AND DISASTER MANAGEMENT DEPARTMENT
******
No. RDM-GOEA-SANC-0098-2015 /R&DM,
From,
To,
The Principal Accountant General (A&E), Odisha, Bhubaneswar.
Sub- Sanction of deputation of ______________ to ______________ as ________
I am directed to convey the sanction of the Governor , under Rule 212(b) of the O.S.C. to the
deputation of ........................ for appointment as ........................ of the said Organisation for the period
from ........................ to ........................ on the following foreign service terms and conditions.
........................ was relieved from the post of ........................ w.e.f. 11.12.2006 and joined the deputation
post on ......................... Leave/joining time for the period from ........................ to ........................ has been
sanctioned vide this Department letter No. ........................ Dt. .........................
2. The period of absence on deputation will be treated as on Foreign Service.
3. During the period of deputation, ........................ will draw pay and Grade Pay in Pay Band-
........................ as fixed by the parent Department below.
Period Pay & Grade Pay Pay Band-2
4. ........................ will be entitled to Dearness Allowance as was entitled against the parent post
under of the State Government.
5. He will be borne in the Cadre of ........................ during the period of her deputation to the
Organisation.
6. The transit pay and T.A for joining the post on deputation and for rejoining his post under
Government on expiry of the terms of deputation shall be borne by the foreign body.
7. During the period under deputation ........................ shall draw T.A. and LTC under the Rules of
the State Government and the expenditure will be borne by the foreign employer.
8. During the period of deputation he will be governed by the leave and pension rules of the
Government.
175 | P a g e
9. During the period of deputation he may receive House Rent Allowance from the Foreign
Employer in accordance with Finance Department Memo No.27670(96)/F, dated 21.08.1963
read with F.D.O.M No.6722/F, dated 15.02.1984, F.D.O.M No.CS-IV-105/F, dated 01.01.1986. In
the event of Foreign Employer providing him a house hired by them, rent not exceeding
admissible of his pay should be realized from him.
10. He/She shall have the option to avail the medical facilities admissible under the rules of the
State Government. Option once exercised in this regard shall be treated as final.
11. The Foreign Employer shall bear the leave salary and pension contribution in respect of the
Officer on deputation as per provisions of the Odisha Service Code. The Foreign Employer shall
pay these contributions as per the monthly rates mentioned below provisionally , subject to
final rate mentioned by the Accountant General (A&E), Odisha.
(i) Pension Contribution (As calculated by the A.G per month)
(ii) Leave Salary Contribution (As calculated by the A.G per month)
The particulars payment of these contributions as and when made by the Foreign Employer
shall be reported by the later to Accountant General (A&E), Odisha under intimation to this
Department.
12. In case of foreign service contribution are found at the end of a particular year, wholly or
partially unpaid and the balance outstanding is more than a month due and it is not paid within
the fifteen days from the close of the year, interest will accrue on the entire outstanding amount
at the rate of 04 paise for Rs.100/- a day for the period from the date of the expiry of the said
grace period of fifteen days till the date on which the amount due at the end of the year is
finally paid.
13. The Foreign Employer shall be liable to bear Dearness Allowance on leave salary in respect of
leave taken by the Officer during the period of his deputation or on termination thereof.
14. The Foreign Employer shall be liable to pay leave salary in respect of any disability incurred in
and through Foreign Service even though such disability manifests just after termination of
Foreign Service.
15. Sri shall not be entitled to any other remuneration or concession of pecuniary value unless it is
specified in terms of his deputation without specific sanction of Government.
16. The deputation particulars of Sri ........................ are sent herewith for reference.
Yours Faithfully
Under/Deputy Secretary to Government
176 | P a g e
Memo No. /R&DM, Dt.
Copy forwarded to the Deputy Accountant General, Odisha, Bhubaneswar / Collector,

__________/ person concerned for information and necessary action.
The Deputy Accountant General , Odisha, Bhubaneswar is requested to intimate the

_____________ /Revenue & D.M. Department the leave salary and pension contribution payable by
the ________ in respect of Sri _________ and to realize the same from the_____.
Under / Deputy Secretary to Government
177 | P a g e
Vigilance Clearance
Dated, Bhubaneswar, the
From:-
Under / Deputy / Secretary to Government
To,
The……………………,
G. A. (Vigilance) Department, Cuttack.
Sub:- Vigilance clearance in favour of Sri / Smt. ...............................................
Sir,
In inviting a reference to the subject cited above, I am directed to request you to please
intimate this Department if there is any vigilance case pending against Sri
Details of particulars is given below for reference.
l. Name : ..............................................................................................
2. Father's/Husband's Name: ..............................................................................................
3. Permanent Address:- At- ......................................... P.O.-....................................
Dist. ...................................... PIN - .....................................
4. Date of Birth:- ..............................................................................................
5. Date of entry into Government Service:- ...........................................................................
OAS/ORS Cadre : ...........................................................................
Since the information is required for confirmation of service/ sanction of pensionary dues/
issue of NOC for obtaining Indian Passport an early action is requested.
Yours faithfully,
Under / Deputy Secretary to Government
178 | P a g e
FOURTH SCHEDULE
FORM FOR EXERCISING OPTION ON THE EVENT OF FIXATION OF PAY ON
PROMOTION/FINANCIAL DEGRADATION UNDER MACPS
[See Rule-12]
I .......................................... holding the post of .......................................... in the Level

.......................................... in Pay Matrix and drawing pay of Rs. .......................................... in the Cell
.......................................... do hereby elect to get my pay fixed in the Level ..........................................
under the ORSP Rules, 2017 on .......................................... i.e. the elate of my joining in the promotional
post or the date of financial up-gradation / the date of accrual of my next increment,
2. The option hereby exercised is final and will not be modified at any subsequent date.
Signature .......................................................
Designation ...................................................
Office .............................................................
Signed before me ...........................................
Head…of…Office/
Any Gazetted Officer....................................
179 | P a g e
House Rent Allowances
i) I certified that I have not been provided with/have not refused the allotment of
Govt.,accommodation during the period in respect of which house rent allowances is
claimed.
ii) I certify that I am incurring expenditure on hiring accommodation for my residential
purposes B.K.MS of my house in Vill/town……………
iii) I am residing in my own house or house owned by my Wife/ Son/ Daughter/ Father/
Mother/ Husband.
iv) I certify that I have retained my family at my old place of posting & I am continuing to
incurred expenditure in hiring accommodation within 8 K.Ms. of my present Headquarters.
v) I have been sent on training from………………..to………………but I have retained my
family in my place of posting………………………………………
Ward NO.
Holding No. Signature of the Officer,
Designation,
Date.
Certificate
I certify that my husband/wife is not a Govt.servant is a Govt. servant who is also

posted at my headquarters & employed at present in the office of
the……………………………………..........................from………………………………………………………
…..date………………. ( herein mention the detail correct address) is in receipt of house rent
allowances/is not in receipt of house rent allowance has been provided with accommodation/has not
been provided with accommodation by……………………
Mention here the Govt/ Govt.Dept
Signature of the Officer,
Designation
Date………………………
180 | P a g e
SECOND SCHEDULE
Application Form for exercising option to come over to the
Odisha Revised Scales of pay Rules, 2017
[See Rule-6]
1. (I) I ____________________________________holding the post of_________________
and drawing pay in the pay Band and grade pay of _______________________________
do hereby elect the revised pay structure with effect from the 1st day of January2016.
(II) I ______________________________holding the post of ______________________

_________________________and drawing pay in the pay Band & Grade pay of ______
___________________do hereby elect to continue on the existing pay Band and Grade pay
until the date__________________(i.e the date of my next increment/promotion or up-
gradation of the post/vacate or case to draw pay in the existing pay structure).
2. The option hereby exercised s final and will not be modified at any subsequent date.
Date:________________
Signature: ____________________________
Designation: ____________________________
Office: _____________________________
Signed before me ________________________

Head of Office/Any other Gazetted Officer with designation received the above declaration
Signature : ___________________________
Head of office/Competent Authority
(With Seal)
Date: ________________________
N.B: Delete whichever is not applicable at Para-1.
181 | P a g e
FORM OF EXCERSING OPTION OF THE EVENT OF FIXACTION OF PAY ON PROMOTION TO
NEXT HIGHER GRADE/POST.
************
(To be submitted to the authority competent to fix the pay)
(Finance Department O.M.No.24495/F.dt.21.6.88)
I……………………………………………………………………………………………………...holding the
………………………….Post of ……………………………………………….in the scale of pay
of……………………………………………………………………………………………………………is
hereby elect to get my pay fixed under Rule 74(d) of Orissa Service code on the date of my joining in
the promotional post ……………………………………………………andrefixed under Rule 74 (b) of
Orissa service code on ………………………………………………………………..i.e on the date of
accrual of my next increment in the lower post. The option hereby exercised is final and will not be
modified at any subsequent date.
Dated
Signature.
Designation.
Office.
Signed before me-
Head of office any Gazetted Officer
182 | P a g e
SECOND SCHEDULE
Application Form for exercising option to come over to the

Odisha Revised Scales of Pay Rules, 2017
[See Rule-6]
1. (i) I ........................................................................ holding the post of .................................... and

drawing pay in the Pay Band and Grade Pay of .................................... do hereby elect the revised
pay structure with effect from the 1st day of January, 2016.
OR
(ii) I ........................................................................ holding the post of .................................... and

drawing pay in the Pay Band and Grade Pay of .................................... do hereby elect to continue
ors the existing Pay Band and Grade Pay until the date .................................... (i.e. the date of my
next increment/ promotion or up-gradation of the post/ vacate or cease to draw pay in the
existing pay structure).
2. The option hereby exercised is final and wili not be modified at any subsequent date.
Date : ....................................
Signature : ....................................
Designation : ....................................
Office: ....................................
Signed before me ....................................
Head of Office/Any other Gazetted Officer With

designation received the above declaration.
Signature : ....................................
Head of Office/Competent Authority
(with seal)
Date : ....................................
183 | P a g e
FORM OF EXERCISING OPTION ON THE EVENT OF FIXATION
OF PAY ON PROMOTION TO NEXT HIGHER GRADE / POST.
******
(To be submitted to the authority component to fix the pay)
(Finance Department O.M. No. 24495/ F. Dt. 21.06.88)
I, .................................... holding the Post of .................................... in the scale of Pay of

.................................... in this scale of pay of ........................................................................ is hereby elect to
get my pay fixed under Rule 74(a) of Orissa Service Code on the date of my joining in the
promotional post .................................... and refixed under rule 74(b) of Orissa Service Code on
.................................... i.e. on the date of accrual of my next increment in the lower post.
The Option hereby exercised in final and will not be modified at any subsequent date.
Dated :
Signature : ....................................
Designation : ....................................
Office: ....................................
Signed before me ....................................
Head of Office any other Gazetted Officer
184 | P a g e
CONFIDENTIAL
GOVERNMENT OF ORISSA
REVENUE AND DISASTER MANAGEMENT DEPARTMENT
MEMORANDUM OF CHARGE SHEET
(UNDER RULE - 15 OF O.C.S. (CC&A) Rules, 1962.
The Government proposes to hold an inquiry against Sri under Rule-15 of the
O.C.S. (C.C. & A) Rules, 1962. The Substance of the imputations of misconduct/ delinquency in
respect of which the inquiry is proposed to be held in set out in the enclosed statement of Articles of
charges (Annexure-I). A statement of the imputations of misconduct/ misbehavior/ delinquency in
support of each Article of charge and the Preliminary reports basing on which the charges are framed
are enclosed (Annexure - II). A list of documents by which and list of witnesses by whom the Articles
of charges are proposed to be proved are also enclosed (Annexure -III).
2. Sri is directed to submit within 30 days of the receipt of the

memorandum a written statement of his defence in duplicate to the address of the Commissioner-
cum-Secretary to Government Revenue and D.M. Department. He is also required to state whether he
desires to be heard in person and desires to examine the witnesses if any for his defence.
3. He/She is informed that an inquiry will be held, only in respect of those Articles of charges as
are not admitted. He should, therefore, specifically admit or deny each article of charge.
4. He/ She may peruse the relevant records and take extract their of if necessary on the basis of
which the charges are framed, in the presence of the Officer with whom the records are available, on
prior appointment.
5. Sri is further informed that if he does not submit his written statement
of defence / explanations on or before the date specified in Para -2 above or does not appear in
person before the Inquiring Authority or otherwise fails or refuses to comply with the provisions of
Rule 15 of the O.C.S. (CC&A) Rules, 1962 or the orders / directions issued in pursuance of the said
Rules the Inquiring Authority may hold the inquiry against him exparte and the proceedings will be
disposed off on merits.
7. The receipt of the memorandum may be acknowledged.
By order and in the name of the Governor.
Commissioner-cum-Secretary to Government
Memo No. ________________________ / R(CS) Dated
185 | P a g e
Copy in triplicate forwarded to the Collector, with request to serve one copy
of the Memorandum on Sri/Smt. at present
and return the other to this Department with dated acknowledgement of Sri on it.
The third copy is for record in his office.
Deputy Secretary to Government
Memo No. ________________________ / R(CS) Dated
Copy forwarded to the Secretary to the R.D.C. (SD) Berhampur/ R.D.C.(CD) Cuttack/ R.D.C.
(ND) Sambalpur for information and necessary action.
Memo No. ________________________ / R(CS) Dated
Copy forwarded to the for information and necessary action

with reference to their letter No. dtd.
Memo No. ________________________ / R(CS) Dated
Copy forwarded to G.O.E. (A) Branch/ G.O.E(B) Branch/ Confidential Branch/ Disc.
Proceeding Branch (02 spare copies) for information and necessary action.
186 | P a g e
ANNEXURE-I
ARTICLE OF CHARGES
During your incumbency you have failed to discharge your duties properly and have
committed gross irregularities as detailed in the statement of imputations.
Therefore the following charges are framed against you for violation of Rule-3 of Government
Servant's conduct Rule, 1959.
ANNEXURE - II
STATEMENT OF IMPUTATION IN SUPPORT OF CHARGES AGAINST

NAME OF OFFICER
ANNEXURE-lll
MEMO OF EVIDENCE
Documents by which the charges is proposed Witnesses by whom the charge is proposed
to be sustained to be sustained
187 | P a g e
GOVERNMENT OF ORISSA
REVENUE & DISASTER MANAGEMENT DEPARTMENT
***Disciplinary Proceeding No………….. /OAS/YYYY
MEMORANDUM OF CHARGE SHEET
[UNDER RULE - 16 OF O.C.S. (CC&A) RULES, 1962]
Name..and..Designation..of..the..Sri
Officer Proceeded against
Scale of Pay
The following charges are framed against you Sri…………………………………..

…………………under Rule-16 of O.C.S.(CC&A) Rules, 1962 for the irregularities committed by you
during your incumbency as
That, you Shri……………………………………………

was transferred and posted as ……………………, of ………….. vide letter No.38498 /R & DM
dt…………………. of Revenue and Disaster Management Department.
That, after relief from the post of ……………………, with effect from 31.10.2009 you did not
join in the post of ………………, …………………...
That, your deliberate attempt not to join as ………………………. amounts to disobedience of

order.
Thus, the following article of charges is framed against you for violation of Orissa
Government Servants Conduct Rules, 1959.
1. Negligence as well as dereliction in duties.
2. Disobedience of orders of Higher Authority.
3. Misconduct.
Your are therefore, called upon to explain in writing within 30 days from the date of receipt of the
charges as to why suitable disciplinary action shall not be taken against you under provisions of the
OCS (CC&A) Rules, 1962.You should submit your explanation in duplicate to the Commissioner-
cum- Secretary to Govt. Revenue & D.M Department within stipulated period. You may peruse the
relevant records and take extracts thereof, if necessary on the basis of which the charges are framed in
the presence of officer with whom the records are available on prior appointment. If no explanation
received by the specified date, it will be presumed that you have no explanation to offer and the
proceeding will be disposal of on merit
By Order of the Governor,
188 | P a g e
Memo No. _________________/ R(CS)„ Dated:
Copy in triplicate forwarded to the …………………………. with a request to serve on copy of

the Memorandum on Sri/Smt……………………………………………….
and return the other copy to this Department with dated acknowledgement of
Sri/Smt…………………….. on it.
The third copy is for record in his office.
Signature of Appropriate Authority
Memo No.R(CS)., Dated:
Copy forwarded to the Secretary to Revenue Divisional Commissioner, ………….Division,

………../ Collector, …………………/ Collector, …………….. for information and necessary action.
Memo No. _________________/R(CS)., Dated:
Copy forwarded to the GOE (A) Branch/ GOE(B) Branch/ Confidential Branch/ Disciplinary
Proceeding Branch (3 spare copies) for information and necessary action.
189 | P a g e
APPLICATION OF A RAIYAT FOR CONVERSION OF
AGRICULTURAL LAD FOR NON-AGRICULTURAL PURPOSE
(See Rule :8A/ (1)(a)
To
The Tahasildar; Bhubaneswar
1. Name of the Raiyat :

2. Father’s husband’s name :
3. Caste :
4. Address :
5. Specific purpose for which the land will be:
utilised after conversion
6. Particulars of land
(a) Mauza
(b) Khata No.
(c) Plot Number
(d) Chaka No.
(e) Area
(f) Classification and status as per current RoR :
(g) Village with thana No. :
(h) Others of any :
7. Whether land is situated in any area within
One half km. on either side of a National
Highway / one fourth km. on either side or
State Highways if so, the details thereof
8. Whether land situated in municipal/ :
NAC/Developing area/rural area. If so,
The details thereof.
9. Date from which the land is intended to
Be used / already used for :
Non-agricultural purpose
10. Source of ownership :
11. Approximate market value of the land :
Date………………… SISNATURE OF THE APPLICANT
190 | P a g e
FORM No. 1
Application for being declared as a raiyat under clause-h of

Sub-section (1) of section 4.
[See sub-section (2) of section 4 and Sub-Rule (1) of Rule 10]
In the court of the Revenue Officer………………
1. Name of the applicant, his parentage

and address.
2. Name of the village in which the land

forming the subject of this application
is situated
3. Identifying particular like survey plot

number , holding number, classification,
area and other details of the land in
question
4. The year from which the land has

been in cultivating possession of the
applicant
5. The amount of rent paid in respect

of each year of occupation up-to date
6. The name, parentage and address

of the landlord directly under whom
the land is held
7. Any other relevant statement which,
The applicant wants to make
Place…………………. Signature of applicant or

Date…………………… his authorized agent
VERIFICATION
I …………………………………………………………….. son of
……………………………………………………………..declare that the facts contained in this
application are true to the best of my knowledge, belief and information.
Place…………………. Signature of applicant or
191 | P a g e
FORM NO.2
Application for being declared as a raiyat under Clause (i) of Sub-section (1) of Section 4
[See Sub-section (5) of Section 4 and Sub-Rule (2) of Rule 10]
In the Court of the Revenue Officer ……………………………………………
1. Name of the applicant, his

parentage and address…………………
……………
is situated…………………….
3. Identifying particulars like survey plot
number, holding number,
classification, area and other details of
the land in question…………………
4. The name, parentage and address of
the landlord directly under whom the
land is held.
5. Any other relevant statement which,
the applicant wants to make.
Place………………….. Signature of applicant or

VERIFICATION
I ……………………………………………………………… son of
………………………………………declare that the facts contained in this application are true
to the best of knowledge belief and information.

192 | P a g e
FORM. 3
Notice of landlord giving particulars of transfer of a holding a raiyat or portion or

share thereof
[See Sub-section (5) of Section 11 and Sub-rule (1) of Rule 14 ]
To
Shri………………………………………………………………………………
Take note that transfer has been effected of the raiyatiland specified below;
1. Description and area of the land transferred with its annual rental
Area
transferred Annual rent of
(where a the area (where
Name portion of a portion has
and the entire been
Holding Survey
Tahasil numbe plot has transferred Remarks
number Plot No.
r of been proportionate
village transferred, annual rent
area of that relating to that
portion be portion)
given)
1 2 3 4 5 6 7
2. Mode of transfer whether by voluntary sale, exchange, gift, bequest or sale in

execution of a decree in Civil/Revenue Court
3. Name of Registration Office where registered, Registration Volume No.,Page No.,
Deed No. and year.
4. I declare in Court or ordered by a Revenue Officer particular of the year and number
of the case, suit execution proceedings etc.
5. Name and address of the transferor.
6. Name and address of the transferee.
7. The name and address of the landlord.
Signature of transferor Signature of Transferee
Item 1 to 6 verified by……………………..
N.B A separate notice should be filed for each village, if the transfer more than one
village.
NOTE. The particular required in item No. 3are to be filed in by the Registered
193 | P a g e
FORM No. 4
Notice of partition of a holding made by a registered instrument
[See Sub-section (2) of Section 19 and Sub-rule (1) of Rule 20]
Shri………………………………………………………………………………………………
……………landlord address…………………………………………
We have effected partition among us in respect of the land given below:
Particulars of land
District……………………Tahasil.............
Village …………………Thana No …………
Khata No…………Survey Plot No…………..
Status of land………………………………
The particulars of partition are shown below:
Name of the Area allotted Rent and cess Remark

Co-sharer demanded
raiyat Survey Plot Area
No
1 2 3 4 5
Signature of Co-sharers/ Raiyat
194 | P a g e
FORM. 5
Notice of partition of a holding made by a decree of a Court
[See Sub-section (4) of section 19 and Sub-rule (1) of Rule 21
From
The Court of ……………………..
To
The Revenue Officer……………………………….
Sir,
Partition has been effected in the decree of this Court in suit No.
……………………….. of the year …………………… in respect of land given in the schedule A
appended. A list of the lands allowed to each share is shown scheduled B.
SCHEDULE ‘A’
Particulars of District………………………………. Tahasil……………………………

land Village ……………………………….. Thana No…………………………
Khata No…………………………….. Survey Plot No…………………
Status of land…………………………
SCHEDULE- ‘B’
Name of the Area allotted Rent and cess Remark

Co-sharer demanded
raiyat Survey Plot Area
No
1 2 3 4 5
Seal ……………… Signature of Presiding Officer of the Court
Date……………….
195 | P a g e
FORM No. 5-A
Notice of partition of a holding made by an order of the Revenue Officer
[See Sub-section (6) Section 19 and Rule 21-A]
From
The Court of ………………………..
To
The Tahasildar/Sub-Registrar……………………..
Sir,
Partition has been effected by order, dated …………………… of this Court in Case
No……………….. more of the year in respect of the land given in the Schedule “A”
appended. A list of the lands allowed to each share is shown in Schedule B.
PARTICULARS OF LAND
SCHEDULE “A”
Particulars of District………………………………. Tahasil……………………………

land Village ……………………………….. Thana No……………………
Khata No…………………………….. Survey Plot No…………………
Status of land………………………………
SCHEDULE “B”
Name of the Co- Area allotted Rent and cess Remark

sharer raiyat demanded
Survey Plot Area
No
1 2 3 4 5
Signature of Presiding Officer of the Court
Date……………….
196 | P a g e
FORM No-6
Application by landlord for determining the resumable and the
non-resumable Lands

and address……………………………………..
is situated………………………………………..
3. Identifying particulars like survery
plot number, holding number,
classification, area and other details
of both the resumable and
non-resumable lands……………………………
4. Name of the tenant from whom land
is proposed to be resumed, his parentage
and address…………………………………….
5. Identifying particulars of the land
selected by the applicant for
resumption……………………………………..
6. Any other relevant statement which
the applicant wants to make…………………..
Place………………………… Signature of applicant or
Date…………………………… his authorized Agent
197 | P a g e
FORM No.7
Application by tenant for issue of a certificate determinant resumable and the non-
resumable lands
In the Court of the Revenue Officer…………………………………

and address……………………………………..
is situated………………………………………..
3. Identifying particulars like survey
of the land in possession of the applicant…………………..
4. The name, parentage and address of the landlord in respect of the land in question
the applicant wants to make…………………………..

Date…………………… his authorized Agent
198 | P a g e
FORM No.8
Certificate specifying the resumable and the
non-resumable lands
(See Sub-section 29 and Sub-rule (1) of Rule 26)
In the court of the Revenue Officer……………………………………….
This is to certify under section 29 of the Orissa Land Reforms Act,1960 that the
lands described in the Schedule A below have seen determined as resumable by
Sri……………………………………………….
Son of…………………………………………..of village ……………………… from

Shri……………………………… son of ………………………………….. of
village……………………….and that the lands described in Schedule B below have been
determined as non-resumable in respect of which the said
Shri………………………………….son of …………………………..of
village………………………shall become a raiyat under the provisions of Section 30 of the
aforesaid Act.
SCHEDULE”A”
(Here give full identifying particulars of the resumable lands)
SCHEDULE “B”
(Here give full identifying particulars of the non-resumable lands)
Given under my hand and seal, this the ………………………….day of…..
20………………………………..
Revenue Officer
Seal
199 | P a g e
FORM No. 9
Draft 1[***] Assessment Roll
[See Sub-section (1) of Section 48 and Rule 35]
1. Name, parentage and address of the person
entitled to 2[an amount] under Sub-section (2)
of Section 47………………
2. Name of the village in which the surplus
land is situated……………………
3. Number of each survey plot of the surplus
land……………
4. Classification of the land contained in each
survey plot………………………..
5. Its area-
(1)In terms of ordinary acres
(2)In terms of standard acres
6. Total extent of the surplus land in standard
acres………………………
7. Name and address of the land-holder if any,
mediately or immediately under whom the
surplus land is held…………………………
8. Rent payable to each land-holder mentioned
in column 7…………………………..
9. Amount payable under Sub-section (1) of
Section 47 to each entitled person…………
10. Amount payable under –
(1)Clause (a) of Sub-section(2) of Section
47.
(2) Clause (b) of the said Sub-section
(3) Clause (c) of the said Sub-section
11. 11.Total 2[amount] payable under Sub-
section (2) of Section 47
12. Other particulars, if any,
13. Remarks
Revenue Officer
200 | P a g e
FORM No. 10
Application for a certificate regarding incapability to cultivate land personally
[See Sub-section (1) & (3) of Section 56-A & Sub–rule (1) of Rule 40]
1. Name of the applicant, his parentage and

address……………………..
2. Reasons in detail in support of the claims for
a certificate………………
3. Any other relevant fact which the applicant
wishes to mention1[if the application is made
on the ground of physical
disability………………………
4. Sources of income other than land……
5. Annual income from the said
sources………………………..
Date…………………………… or his authorized Agent
his guardian as the case may be
201 | P a g e
FORM No.11
Certificate regarding incapability to cultivate personally
[See Sub-section (2) & (3) of Section 56-A & Sub-rule (4) of Rule 40]
…………………………………………………………………………………2[* * *]
……………………………………………………………………………………………………
……………………………………………..
Court of the Revenue Officer ……………………………………………………….
This is to certify that Shri……………………………………………son of ……
…………………………………………of village ……………………………..in

Tahasil………
Is incapable of cultivating his lands personally because of the fact that he is (here
record the exact person)
……………………………………………………………………………….
2[***]
Date ………………………………. Revenue Officer
Seal
202 | P a g e
FORM No. 17
[Application for being declared as a raiyat under Sub-Sec rule (1)(a) of Section 19]
In the Court of the Revenue Officer……...........................................................

and address………………………………
2. Whether the applicant is a Raiyat or Tenat of any land, if so detail particulars of
the said land………………………………….
is situated………………………………………..
4. Particulars of the land, i.e.
of the land in question …………………………………………
5. Name, parentage and address of the land lord owning the land mentioned in
Column 4 above ……………………………………
the applicant wants to make…………………………..
VERIFICATION
I, …………………………………………………..son of
………………………………………………declare that the facts contained in this
application are true to the best of my knowledge , belief and information.
Place…………………………………….. Signature of
applicants
203 | P a g e
FORM No.18
[ Application for surrender of abandonment of land by a raiyat or tenant under Sub-

section (2) of Section 22-A ]
In the Court of the Revenue Officer……...........................................................
1. Name of the applicant, his parentage and

address……………………………
forming the subject matter of this application
is situated………………
3. Identifying Particulars like survey plot
number, holding No, classification, area and
other details of the land in
question…………………………………
4. Name of the land lord/lords under whom
the land is held with his Parentage and
address………………
5. Amout of rent paid to the land lord
…………………………………………
6. Reason for the surrender or abandonment
………………………..
7. Any Other relevant statement which the
applicant wants to make………..
Place……………………………………
Signature of applicant or
his authorized Agent
Date ………..
VERIFICATION
I, …………………………………………………..son of
………………………………………………declare that the facts contained in this
application are true to the best of my knowledge, belief and information.
204 | P a g e

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Table of Contents

Sl No Name of the Section Form Application Forms Page

APPLICATION FORM FOR ISSUANCE OF RESIDENT CERTIFICATE

Name of Applicant _____________________________________________________ Paste

Gender _________________ Marital Status ________________ Applicant’s

Age _________________ Religion ________________ (Passport size)

Father’s Name _____________________________________________________

Husband’s Name _____________________________________________________

Mobile No. ___________________ Aadhaar No. ________________

Village/ Town: __________________ Police Station: ________________ Post Office: _______________

Tahasil: _______________________ District: ______________________ Pin: ______________________

Village/ Town: __________________ Police Station: ________________

Tahasil: _______________________ District: ______________________ Pin: ______________________

Relation with applicant:__________________________________________

7. List of Documents attached: [see note (a) of rule 3]

Mouza (Revenue ______________ KhataNo ____________________

Recorded Tenant (Land _____________________________________________________

Relation of the applicant with Recorded Tenant ___________________________________________

ii)Voter ID / Aadhaar Card / PAN card / Passport / etc.

I, Shri/Miss/Mrs_____________________________ Son of / Daughter of / Wife

Strike out which is not applicable

[See Rule 4 (1)]

APPLICATION FORM FOR ISSUANCE OF LEGAL HEIR CERTIFICATE

Gender _______________ Marital Status __________________ Paste

Age _______________ Religion __________________ Photo

Father’s Name _______________________________________________________

Husband’s Name _______________________________________________________

Mobile No. _______________ Aadhaar No. ______________________

Village/ Town: __________________ Police Station: ________________

Tahasil: _______________________ District: ______________________ Pin: ______________________

Village/ Town: __________________ Police Station: ________________ Post Office: _______________

Tahasil: _______________________ District: ______________________ Pin: ______________________

Submitter's Name (in case the submitter is not the applicant):______________________________

Relation With Applicant:__________________________________________

Age:_______ Gender:_________ Place of Death:_______________Date of death: _________

7. Legal heir details:

8. List of Documents attached

i) Voter ID / Aadhaar Card

ii) Copy of death certificate

I, Shri/Miss/Mrs_____________________________Son of / Daughter of / Wife of

Date: Signature of the Applicant /

APPLICATION FORM FOR ISSUANCE OF INCOME CERTIFICATE

Name of _____________________________________________________ Paste

Father’s Name _____________________________________________________

Husband’s Name _____________________________________________________

Mobile No. ___________________ Aadhaar No. _________________

Village/ Town: __________________ Police Station: ________________

Tahasil: _______________________ District: ______________________ Pin: ______________________

Village/ Town: __________________ Police Station: ________________ Post Office: _______________

Tahasil: _______________________ District: ______________________ Pin: ______________________

Submitter's Name (in case the submitter is not the applicant):______________________________

Relation With Applicant:__________________________________________

7. Total Income (in Rs): ___________________________________

I, Shri/Miss/Mrs___________________________________Son of /Daughter of/ wife of

___________________________ age _________________ of _____________________ (detailed

Strike out which is not applicable

APPLICATION FORM FOR ISSUANCE OF SOLVENCY CERTIFICATE

Age _________________ Religion __________________

Father’s Name _____________________________________________________

Husband’s Name _____________________________________________________

Mobile No. ___________________ Aadhaar No. ____________________

Village/ Town: __________________ Police Station: ________________

Tahasil: _______________________ District: ______________________ Pin: ______________________

Gender _ Marital Status Applicant’s

Age _ Religion (Passport size)

Mobile No. ___ Aadhaar No.

Village/ Town: ____ Police Station: Post Office: _

Tahasil: _ District: Pin: __

Village/ Town: __ Police Station:

Tahasil: _ District: Pin: __

Mouza (Revenue KhataNo ______

Gender _ Marital Status ____ Paste

Age _ Religion ____ Photo

Mobile No. _ Aadhaar No. ________

Village/ Town: __ Police Station:

Tahasil: _ District: Pin: __

Village/ Town: ____ Police Station: Post Office: _

Tahasil: _ District: Pin: __

Age:___ Gender:_ Place of Death:___Date of death: _

Mobile No. ___ Aadhaar No. _

Village/ Town: __ Police Station:

Tahasil: _ District: Pin: __

Village/ Town: ____ Police Station: Post Office: _

Tahasil: _ District: Pin: __

___________________ age _ of _____________ (detailed

Age _ Religion __

Mobile No. _ Aadhaar No. __

Village/ Town: __ Police Station:

Tahasil: _ District: Pin: __

Village/ Town: ____ Police Station: Post Office: _

Tahasil: _ District: Pin: __

___________________ age _ of _____________ (detailed

Gender _ Marital Status Applicant’s

Age _ Religion (Passport size)

Mobile No. _ Aaadhar No. _

Village/ Town: __ Police Station:

Tahasil: _ District: Pin: __

Village/ Town: ____ Police Station: Post Office: _

Tahasil: _ District: Pin: __

___________________ age _ of _____________ (detailed