APPENDIX – I
FORM B
(See Rule 4.1)
The Tree Officer,
……………………
Sir,
I apply for grant of permission for felling tree/s located in the property situated in the village…………. Taluka………. and District……… I furnish below the following details in support of my application: -
i) Applicant’s name and address (In block letters)
ii) Name and address of the owner of the property (if different from applicant)
iii) Title of the applicant i.e. whether owner/occupant of the property, etc.
iv) Name and serial number of property
v) Total area of the property with description of the boundaries
vi) Total number of trees (species- wise) whose trunk or body is not less than 5 cm. in diameter at a height of 30 cms. from the ground and whose height is not less than one metre from the ground
vii) The exact area (in sq. meters) from which felling of trees for which permit is sought (description of the boundaries)
viii) Total number of trees to be felled
ix) Trees to be felled are numerically numbered in paint, their girth measured at a height of 1.35 meters from ground level and their details species wise are
x) Purpose for which the felling of trees are intended
xi) Intended use of felled trees (e.g. for sale, for domestic use, etc.)
xii) Intended use of land after felling of trees
xiii) Number and species of trees intended to be planted after felling (give details of arrangements for raising, planting and protecting trees)
xiv) Name/s and address/es of the owners/occupants adjoining property/ies
2. I am enclosing an affidavit and below mentioned papers in support of my application.
Declaration
I hereby declare that I shall fully satisfy and abide by such terms and conditions of the permit as may be specified therein.
Place:-
Date:-
APPLICANT’S SIGNATURE
Attested copies of :-
1. Property/occupancy documents.
2. Plan of the property showing the survey number.
3. Enumeration list (duly signed by the applicant).
4. Boundary list (duly signed by the applicant).
5. Latest index of land record issued by the Mamlatdar.
6. N.O.C. from Administrator of Communidade.
7. N.O.C. from adjoining property owners:
Affidavit
(To be signed on a stamped paper in the presence of Magistrate or authority approved for the purpose)
I, ……… aged …… years, resident of ………(locality)……….. village ……. Taluka,
Goa District, wife/son/daughter of………… do hereby solemnly affirm and declare as
under:
1. That I am the legal owner/occupant of the private property known as “ ………..”
situated at ……….. Village ………… Taluka bearing cadastral survey
number……… of., boundaries of which are as follows:-
East:
West:
North:
South:
2. That I have applied to the Tree Officer, ………. for permission to fell …….(number) trees from the aforesaid property. All the trees have been numbered with paint.
3. That there is no other owner/occupant of this property or of the forest produce of this property and I hereby solemnly affirm and declare that I shall be solely responsible and answerable for any claim and litigation, if any, that may arise at any time in future regarding the ownership/occupancy of the said property or the forest produce from the said property.
4. I hereby solemnly declare and affirm that to the best of my knowledge and belief the information is correct and true and nothing material has been concealed and is false.
Place:
Date:
DEPONENT