Application Form

For
Certified Copy of Deed

Applicant Details

1. Salutation*: _____________
2. First Name*:_____________________________
3. Middle Name: _____________________________
4. Last Name *: ________________________________
5. Mobile No.:_________________________
6. Email: ________________________

Address of Applicant

7.24. Name of Block/Municipality/Corporation *:________________________________

Address Line 1*:__________________________________________________________
tered Worker
8. Address Line 2:___________________________________________________________
9. Rural/Urban*: __________________________
10. Sub-Division:____________________________________
11. Block/Municipality/Corporation: _____________________________
12. Name of Block/Municipality/Corporation: ________________________________
13. PIN Code*:____________________
14. Post Office: ____________________________
15. Police Station: ________________________
16. District*: ______________________
17. State*: _______________________
18. Country*:________________

Deed Details
24. Name of Block/Municipality/Corporation *:________________________________
19. Year to which the search or inspection relates*: _____________________________
tered Worker
20. Reference to previous application for inspection

of register book or other secrets [Application No. of Inspection]*:_________________

21. Nature of document *:_______________________________

22. The office to which relates *:_____________________________

23. Number with year of the document *:___________________________________________

24. Volume and pages of the book in which copied *: _________________________________

25. Deed No*:_________________________

26. Registered in Book*: _____________________

27. Volume*:_______________

28. Pages*:_________________

29. Fees paid [G(a)]*:__________

30. Fees Paid [G(b)]*:__________

31. Remarks*:_________________________________________________________________

I hereby declare that the above information is true to the best of my knowledge and belief.

Signature: ______________________________________

Date of Application: ______________________________