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Go 31.2012.rd dt 23.01.2012

Prasanth Gopalakrishnan
Prasanth Gopalakrishnan

This document appears to be an application form for assignment of land on registry in the state of Kerala, India. It requests information from applicants such as name, address, contact details, details of any land already owned, and whether the applicant qualifies for priority assignment as a landless or disabled person. The form has sections to provide details of total land in possession as well as the specific land parcel for which assignment is requested, including location, boundaries, size and current status.

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of KeEIa ouddocd .#'f -t l:iluu;ry )u' ti :f t{ ri t; t! ,l ii ii .Tiituvaaanurapuii *,.';:,';t &;:L,T (or8s6 , -._wvrr|l" oF KERAl,q Reverue (p) Departmenr NOTIFIC4TION Rurrs 2012 J,i!i,,1#,tk:x:::y-.) rlrese,,,r-^ 'il ;_T;:-r;::T:j,,:::t,H;seru,esmardecarred,he :3t""iri^,***:*r",it'Jr;,ii?;ua8J"lml,
1 "* fV"APPeut [See Rule 1 i (8) and.16 (1)l Application Form forAssignment o{ Land on Regtsiry I. Narne ofaPPlicant 2. Nalionaliry olthc aPplicant f . ,lg" 'nO Date of Birth 4. Name of Wife 'Husband , : 5 Present address r Dcrmanent address{As given rn " ni'i* curo eiection'Card' Passpofl or UID Card) ': 1:Tfi'j:[:::ff# lJilJi., (a) Ration Card numbe @) Election Card nrimb (c) UtD Card number (d) Passport numbr 8. Phone numbe":'il1i"ll11*,-, re aPolicarrt al the ttme u ' (a) Mohile Phone ft) Land Pbone o Whether the aPplicant belongs to ' *,:Hil;^;) rIY""'nu'"th' category !n hetber thc aPPiicant is an 'u l--tt}t"^"" (Yes'lo) I{Yes' give details : the applicant is disabled active military service ora ofthose who killed active military sen ice ). Ifyes, give details the appJicant belongs to holders' with annual incdme r than. ( 25,000 ). If yes, give details the applicant is a recipient award from Military of such a person ). If yes, give dehils and annual family of the applicant of assignment site/cultivationrbenefi cial of Iand in possession/ of land owned or occupied r applicani and/or his fanrilv cm (iointly o.r severdliyJ .# I E{ent (Aqr'Cent/Sq, Merre)
4 PART I lDetails of total land in Possgsslon Dand in Pqssession' situated in- (a) Mllage O) Tahi( ' G) Distriot 6) SurveyNunbet "*lJll,"Ilt::", centsi sq m etre) 3. Boundaries ofland in possessiort- (a) . South 'O) Nonh (c)'East (d) West 4. Nature ofland (wet or dr,) Teriure of land (Re*'.* TT::' i JJ,]*"'*",n*o"Putotobf 5er larr .{f ,n and enjoYment of the rs a Iandlesq person or u O"r*gd9, o""upying any landj sDistrist to rvhich priority is for assignrnent Districts to which priority is Fir.st Second Third' Fourth Fiftl CDScrlS lL<rD,zou,Jvv r:,._-

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Go 31.2012.rd dt 23.01.2012

  • 1. of KeEIa ouddocd .#'f -t l:iluu;ry )u' ti :f t{ ri t; t! ,l ii ii .Tiituvaaanurapuii *,.';:,';t &;:L,T (or8s6 , -._wvrr|l" oF KERAl,q Reverue (p) Departmenr NOTIFIC4TION Rurrs 2012 J,i!i,,1#,tk:x:::y-.) rlrese,,,r-^ 'il ;_T;:-r;::T:j,,:::t,H;seru,esmardecarred,he :3t""iri^,***:*r",it'Jr;,ii?;ua8J"lml,
  • 2. 1 "* fV"APPeut [See Rule 1 i (8) and.16 (1)l Application Form forAssignment o{ Land on Regtsiry I. Narne ofaPPlicant 2. Nalionaliry olthc aPplicant f . ,lg" 'nO Date of Birth 4. Name of Wife 'Husband , : 5 Present address r Dcrmanent address{As given rn " ni'i* curo eiection'Card' Passpofl or UID Card) ': 1:Tfi'j:[:::ff# lJilJi., (a) Ration Card numbe @) Election Card nrimb (c) UtD Card number (d) Passport numbr 8. Phone numbe":'il1i"ll11*,-, re aPolicarrt al the ttme u ' (a) Mohile Phone ft) Land Pbone o Whether the aPplicant belongs to ' *,:Hil;^;) rIY""'nu'"th' category !n hetber thc aPPiicant is an 'u l--tt}t"^"" (Yes'lo) I{Yes' give details : the applicant is disabled active military service ora ofthose who killed active military sen ice ). Ifyes, give details the appJicant belongs to holders' with annual incdme r than. ( 25,000 ). If yes, give details the applicant is a recipient award from Military of such a person ). If yes, give dehils and annual family of the applicant of assignment site/cultivationrbenefi cial of Iand in possession/ of land owned or occupied r applicani and/or his fanrilv cm (iointly o.r severdliyJ .# I E{ent (Aqr'Cent/Sq, Merre)
  • 3. 4 PART I lDetails of total land in Possgsslon Dand in Pqssession' situated in- (a) Mllage O) Tahi( ' G) Distriot 6) SurveyNunbet "*lJll,"Ilt::", centsi sq m etre) 3. Boundaries ofland in possessiort- (a) . South 'O) Nonh (c)'East (d) West 4. Nature ofland (wet or dr,) Teriure of land (Re*'.* TT::' i JJ,]*"'*",n*o"Putotobf 5er larr .{f ,n and enjoYment of the rs a Iandlesq person or u O"r*gd9, o""upying any landj sDistrist to rvhich priority is for assignrnent Districts to which priority is Fir.st Second Third' Fourth Fiftl CDScrlS lL<rD,zou,Jvv r:,._-