Department: REVENUE

APPLICATION FOR LAND HOLDING CERTIFICATE

(Marked Fields are mandatory)
(*চিহ্নযু ক্ত তথ্যব োৰ োধ্যতোমূ লক)
Language of the Certificate English Assamese Bengali Bodo
( )

Applicant Details
Applicant's Name ………………………….
Applicant's Gender Male Female
Applicant's Mobile No ………………………….
Applicant Email Id ………………………….
Aadhar Number ………………………….
PAN Number ………………………….

Address Details
*State (ৰোজ্য) ………………………….

*District(চজ্লো) ………………………….

*Sub-Division (মহকুমো) ………………………….

*Circle Office(ৰোজ্হ িক্র) ………………………….

*Village/Town(গোওঁ/নগৰ) ………………………….

*Police Station(থ্োনো) ………………………….

*Post Office(ডোকঘৰ) ………………………….

Mouza ( ) ………………………….

*Pin Code(চিন নং) …………………………. (e.g 78xxxx)

Signature of the applicant

(আব দনকোৰীৰ িোক্ষৰ)
 Department: REVENUE
APPLICATION FOR LAND HOLDING CERTIFICATE

Land Details
Name of the Pattadar ………………………….
Guardian Name of Pattadar ………………………….
Relationship
Self Son Daughter Mother Father Wife
Husband Brother Sister Grand Daughter Grand Son
Grand Father Grand Mothers Others
Location of Daag ………………………….
Lot No ………………………….
Patta No ………………………….
Patta Type Annual Patta Periodic Patta
Whether Land Revenue Paid? Yes No
Reason for availing ………………………….
Land Village/Town ………………………….

Attachment Section
1. Any other document

Signature of the applicant

(আব দনকোৰীৰ িোক্ষৰ)