APPLICATION FOR REGISTRATION OF A PLANTATION 1. Name and location of Plantation. __________________________________________ 2. Full Name and particulars including percentage and residential address and postal address of (i) The employers of the Plantation in case of a private firm/proprietary concern. (ii) Directors in the case of company/Firm (iii) The Chief Administrative head of the Department in the case of a Government of Local fund Plantation. 3. Full name and address of the Manager or parson responsible for the supervision and control of the Plantation. __________________________________________________ 4. (a) Area of the Plantation indicating khasra number and area of each khasra._________ (b) Area of land actually under Plantation in the khasra number and their areas. ________ 5. Maximum number of workers employed on any day during the last twelve months. 6. Particulars of treasury receipt enclosed...............(Name of treasury amount and rate) I hereby declare that the particulars given above are true to the best of my knowledge & belief. Signature of Employer. Place Dated
