GOVERNMENT OF GOA DIRECTORATE OF SETTLEMENT & LAND RECORDS, PANAJI GOA. OFFICE OF THE INSPECTOR OF SURVEY & LAND RECORDS APPLICATION FORM FOR CERTIFIED COPY OF FORM III/ *JUDGEMENT & ORDER IN D.C. Nos. :___________________________________ Village :___________________________________ 1) Name of the Applicant : 2) Residential Address : I) House No. : ______ __________________ ii) Ward : ________________________ iii) Village : ________________________ iv) District : ________________________ v) Taluka : ________________________ Details of Property 3) Village : ______________________________ 4) Taluka : ______________________________ 5) Survey No./SubDiv.No : ______________________________ Signature of the Applicant. For Office use. * Court fee stamp of Rs.2/to be affixed on application form