APPENDIX - II
FORM C
[See Rule 4 (2)]
To
The Tree Officer and
…………………………….
…………………………….
Sir,
I apply for grant of permission for removal and disposal of tree/s located in the
property situated in the village…….. Taluka…….. and District……… I furnish below
the 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) from
which trees were felled.
iii) Title of the applicant i.e. whether owner/
occupant of the property etc. from which
trees were felled.
iv) Name and serial number of the property
from which trees were felled.
v) Total area of the property with description
of the boundaries.
vi) Total number of felled trees (species wise)
whose trunk or body is not less than 5 cm.
in diameter at a height 30 cm. from the
ground and whose height was not less than
one meter from the ground.
vii) Describe the circum-stances under which
the tree/s was/were felled i.e. whether the
tree/(s) was/were felled after obtaining the
permit (a copy of the permit is to be
enclosed) or under the provision to section
8 of the Ordinance or had fallen due to
natural causes, etc.
viii) Details of material obtained from the felled
tree.
First class timber … cu.m.
Second class matti … cu.m.
Second class (other)… cu.m.
Third class timber … cu.m.
Firewood … cu.m.
First class Poles … Nos.
Second class Poles … Nos.
Third class Poles … Nos.
ix) The manner in which the material would
be removed i.e. by road, rail, waterways
and the mode of transport.
x) Transit route
xi) Removal of the material completed by
(date).
xii) The material is intended to be disposed
in the manner indicated below: -
a) For self use Quantity
First class timber … cum.
Second class matti … cu.m.
Second class (other)… cu.m.
Third class timber … cu.m.
Firewood … cu.m.
First class Poles … Nos.
Second class Poles … Nos.
Third class Poles … Nos.
b) By sale Quantity
First class timber … cu.m.
Second class matti … cu.m.
Second class (other)… cu.m.
Third class timber … cu.m.
Firewood … cu.m.
First class Poles … Nos.
Second class Poles … Nos.
Third class Poles … Nos.
c) Name (s) and full Address /es of the
persons/parties to whom the material
would be disposed by sale.
d) Licence number of the purchaser (if purchaser is holder of a licence issued by Forest Department).
I am enclosing 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: -
a) Property/occupancy documents.
b) Plan of the property showing the survey number.
c) Boundary list (duly signed by the applicant)
d) Latest Index of Land record issued by the Mamlatdar.
e) Report, if any, made pursuant to provision to section 8 of the Ordinance.
f) Permit, if any, granted by the Tree Officer.