FORM A
[(See rule) 3 (3)]
(Application for Registration)
To,
………………………
………………………
………………………
………………………
………………………
Sir,
I/We you to kindly register me/us under rule 3 of the Goa (Prevention of Illegal Mining
Transportation and Storage of Minerals) Rules, 2004.
(2) A sum of Rs 1000/- being the fees for registration payable under sub-rule 3 of rule 3
of the said Rules have been deposited vide challan No…………….. Dated………………. Of the State Bank of India/Treasury ……………………….
(3) The required particulars are given below:-
(vi) Name of the applicant.
(vii) Address of the applicant.
(viii) Is the applicant a private individual/cooperative/firm/association/private company/Public company/public sector undertaking/ joint sector undertaking or any other.
(ix) In case the applicant is:-
(d) An individual, his nationality.
(e) Firm or association, the nationality of all the partners of the firm or members of the association.
(f) A company, an attested copy of the certificate of registration of the company shall be enclosed.
(x) Nature of business.
(xi) Location of Staking site with Survey Number.
I/We do hereby declared that the particulars furnished above are correct and am/are ready to furnish any other details, including accurate plans as may be required by you.
Yours faithfully,
(Signature and designation of the applicant)
Place
Date
FORM A
Received “To be submitted in quadruplicate”
At………
(Place) on ………….
(Date)
Initial of Receiving Officer
GOVERNMENT OF ………….
(APPLICATION FOR RECONNAISSANCE PERMIT)
(See rule 4)
Dated day of 20…….
To
Through
Sir,
I/We request that a reconnaissance permit under the Mineral Concession Rules, 1960 be granted to
me/us.
2. A sum of Rs ………….. being the fee in respect of this application at the rate of Rs5/- per square
kilometer or part thereof payable in accordance with the Mineral Concession Rules, 1960 has been
deposited.
3. The required particulars are given below:-
(i) Name of the applicant with complete address.
(ii) Is the applicant a private individual/private company/public company/firm or association?
(iii) In case applicant is:-
(a) an individual, his nationality;
(b) a company, an attested copy of the certificate of registration of the company shall be enclosed;
(c) firm or association, the nationality of all Partners of the firm or members of the association;
(iv) Profession or nature of business of applicant;
(v) No. and date of the valid clearance certificate of payment of mining dues(copy attached);
(vi) If on the date of application the applicant does not hold a reconnaissance permit, it should
be sated whether an affidavit to this effect has been furnished to the satisfaction of the State Government;
(vii) Mineral or Minerals which the applicant intends to prospect;
(viii) Period for which the reconnaissance permit is required;
(ix) Extend of the area the applicant wants to prospect;
(x) Details of the area in respect of which reconnaissance permit is required;
…………………………………………………………………………………………………………………
District Taluka Area
…………………………………………………………………………………………………………………
(xi) Particulars of the areas mineral-wise within the jurisdiction of the State Government for
which the applicant or any person joint in interest with him.
(a) already hold under reconnaissance permit;
(b) has already applied for but not granted;
(c) being applied for simultaneously;
(xii) Nature of joint interest if any;
(xiii) If the applicant intend to supervise the work, his previous experience of reconnaissance
prospecting and mining operations should be explained; if he intends to appoint a
manager his qualifications, nature and extend of his previous experience should be
specified and his consent letter should be attached;
(xiv) Financial resources of the applicant;
(xv) Particulars of receipted treasury challan attached for the amount referred to at 2 above;
(xvi) The work proposed to be undertaken along with their physical annual targets;
(xvii) The Scheme of relinquishment of the area;
(xviii) Anticipated minimum annual expenditure (activity of work wise);
(xix) Any other particulars or sketch map which the applicant wishes to furnish.
I/We do hereby declared that the particulars furnished above are correct and am/are ready to furnish any other details, including accurate plans as may be required by you.
Yours faithfully,
(Signature and designation of the applicant)
Place
Date
The topographical map of 1” = 1 mile scale 1[or 1:50,000] is obtainable from the office of the Survey of
India Hathibarkhala, Dehradun.
Details plan and topographical map to be attached in quadruplicate with the original application.
Note: 1 If the application is signed by an authorized agent of the applicant. Power of Attorney should be attached.
2. The application should relate to one compact area only.