FORM No. 25
Application of a Raiyat for conversion of agricultural land for non-agricultural purposes
(See rule 12-A (1) (a) )
To
The Authorised Officer
1.Name of the Raiyat ----------------------------------
2.Father’s/Husband’s name ----------------------------------
3.Address ----------------------------------
4.Specific purpose for which the land Will be
utilised after conversion.
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1.Particulars of land :
a.Holding Number :
b.Plot Number :
c.Area :
d.Classification and status as per Current
R.O.R.
:
e.Village with Thana Number :
f.Others, if any
:
Whether land is situated in any area Within
one-half Km. on either side of
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A National Highway/ One/ fourth Km. ----------------------------------
On either side of State Highways, if so, ----------------------------------
The details thereof. ----------------------------------
1.Whether the land situated in a
Muncipal/N.A.C,/ Developing area/Rural area,If
so, the details thereof.
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1.Date from which the land is intended To be
used/already used for non-Agricultural
purpose. ----------------------------------
1.Source of ownership ----------------------------------
2.Approximate market value of the land ----------------------------------
Date : Signature of the applicant