(To be printed on the Letter Head of the Headman/Sordar/Nokma council)

ANNEXURE II - CLAN LAND

FORMAT OF CERTIFICATE FOR AVAILING FARMER’S IDENTITY CARD

(DOCUMENTARY PROOF)

AGRICULTURE LAND USE DECLARATION

This is to certify that Shri/Smt _______________________________________ a resident of

Village ____________________ under ___________________________ CD Block
___________________________ District ____________________ , is a bonafide farmer who is
cultivating on clan land of approximate ___________________________ (Acre) for agriculture
purpose only.

*This certified copy is specifically meant for availing benefits from Government

MOBILE NO:_________________________________________ AC No._____________________

BILSIO TANGKA MAN’A (INCOME) __________________ (TANGKA GONG__________________)
A.ANI DALA_______________ BIGHA KETA _______________________ (MI,TERIK,SIMU ETC)
BILSIO MAN.A _______________QUINTAL, P.RAIANI GADANG___________________________

SOI/SIGN.