GOVERNMENT OF ANDHRA PRADESH MODEL FORM - R Application for Transfer of Licence / Lease for Granite See Rules 12(5)(h) (viii) Dated the ............ day of ........ 20 Received Latest passport size Latest passport size Photo (Transferor) Photo (Transferor) At ................(Place) Attested by a Gazetted Attested by a Officer to be Affixed Gazetted Officer to On ...............(Date) be Affixed Initial of Receiving Officer : To : Through : Sir, I/We request for sanction of Transfer of my / our Licence / Lease under the APMMC Rules, 1966. 2. A sum of Rs. 5000/- (Rupees Five thousand only ) being the fee in respect of this transfer application has been deposited (Vide receipt Challan No. . . . . . . . . . . . . . . . . . . . . . . . . . Dated . . . . . . .. . . . . . . of the State Bank of India / Treasury . . . . . . . . . . . . . . . . . . . . . . . . . . . . ) 3. The required particulars are given below: I Name and address of the Transferor (Original Licence / Lease) 1. Mineral Extent 2. Sy. No. 3. Village 4. Mandal 5. District II Location of the area proposed for transfer III Extent of the area proposed for Transfer IV No. and date of Grant of the Licencee / lease V Date and Execution and period of the Licencee / lease VI Name and Address of the Transferee to whom the licence / lease is proposed for Transfer VII Whether valid MRCC of the transferor and transferee are filed. VIII Whether consent of both the parties for the transfer in the form of an affidavit is filed IX Reasons for Transfer X Whether any financial Consideration is involved in the Transaction, if so the details thereon Place: Signature of the Transferor Date: Signature of Transferee Note: 1. Sketch of the area delay indicating the area granted in favour of the transferor with signature of the Transferor are be attached in Triplicate 2. Sketch of the area duly indicating the area intended for transfer duly signed by transferor and transferee is to be attached in Triplicate. 3. The application should relate to One compact area only
