F O R M-"A" Application for Quarrying Lease ( See Rule - 5 ) From: Dated:_________. Telephone No. To, The Director , Directorate of Mines, Udyog Bhavan, Panaji Goa. Sir, 1. I/We submit an application for a quarrying lese for extraction of ____________( mineral ) for a term of ______________ years over ______________ Ha./Sq.mts of land in the area specified in the Annexure hereto appended. 2. The fees of Rs. 300/has been paid in the Government Treasury at _______________ ( place ) and the receipted challan is enclosed. 3. The required particulars are given below: (i) Name of the applicant, stating whether he or it is an individual firm, company or society._________________. (ii) Nationality of the individual or place of registration or incorporation of firm, company, society _________________. (iii) Profession of the applicant _________________________. (iv) Address of the applicant ___________________________. (v) Minor Mineral/Minerals which the applicant intends to quarry._________________________________________. (vi) Period for which the lease is required _________________. (vii) Approximate quantity of mineral expected to be raised during the first year ________________________________. (viii) Particulars of the area, mineral wise within the State, for which the applicant or any person jointly is interested with him: a) Already holds a quarrying lease _________________________. b) Has already applied for quarrying lease but not granted ____________________. c) Being applied for simultaneously, _______________________. d) Nature of joint interest, if any ___________________________ (ix) Means by which the mineral/minerals is/are to be raised i.e. whether manual or mechanical. (x) Manner by which the mineral raised is to be utilized _____________. (a) for manufacture _________________ (b) for sale _______________________ (c) for any other purpose _________________ (xi) Detail of the plan of the area applied for to be enclosed : ( The plan should be on the relevant portion of the cadastral village map with scale and should contain natural features, landmark or other features to enable identification of the area in the field, the nearest railway station, or any other place of importance ). (xii) Is the area applied for in contiguous block? ___________________ (xiii) Has the applicant any previous experience in quarrying ? If yes, details thereof __________________________ (xiv) Financial resources of the applicant ______________________ (xv) Total investment in the operations anticipated _______________ (xvi) Particulars of the receipted treasury challan for the fees _____________ (xvii) Any other particulars which the applicant wishes to furnish ____________ ANNEXURE 1. Name of the village/forest/range _____________________ 2. Details of the area applied for in each survey No._________ 3. Full description of the area applied for with regard to natural features ______________________ 4. Taluka _______________________ I/We hereby declare that the particulars furnished above are correct and am/are ready to furnish any other details, plans etc. as may be required. Yours faithfully, Signature of the applicant Place: Date: N.B. If the application is signed by an authorized agent of the applicant, the power of attorney should be attached.
