Application forms Form-A (See Rules 5, 10 and 13) Received at (Place)........................................................................................................... On (date)...................................................................................................................................... at (hour) .................................................................................................................................... Initials of Receiving officer ........................................................................................................... Application for Quarrying Permit (For all types of lands) *(To be submitted in Triplicate) From To The GeologistDistrict Office of the Dept. of Mining and Geology, .....................................District. Sir, I / We request that a quarrying permit under the Kerala Minor Mineral Concession Rules 1967 may be granted to me /us. 2 A sum of Rs. 200 being the fee in respect of this application payable under rule 6 of the said rules has been deposited; 3 The required particulars are given below: (i) Name & Complete address of the applicant (ii) Is the applicant a private individual/ private company / public company / firm or association. (iii) In case applicant is, (a) an individual, his nationality (b) a private company, the names and nationality of all members and place of registration. (c) a public company, the names and nationality of the Directors, the percentage of sharecapital held by Indian Nationals and place of incorporation. (d) firm or association; the names and nationality of all the particulars of the firm or members of the association and place of registration. (iv) Profession or nature of business of the applicant (v) Name / Names of the minor mineral / minerals to be quarried (vi) Quantity of the minor mineral /minerals for which permit is required (vii)Full description of the land from which the mineral is to be quarried. an attested copy of a survey map of the area showing survey Nos. Boundary Nos. etc., should be submitted. The area should be coloured in red vide sub rule (2) Rule (5). (viii)Particulars of the documents showing nature of tenure of the land and ownership of the land District : Taluk : Panchayat : Village :Survey No : Area : (ix) Details of consent letter from the land owner permitting surface operation. (x) Purpose for which the minor mineral is to be used. 4 Particulars of the receipted treasury chalan attached for the amount referred to at 2 above. 5 I / We do hereby declare that the particulars furnished above are correct and am / are ready to furnish any other details as may be required by you. I / We agree to pay the advance the royalty that may be assessed on the quantity of mineral (s) proposed to be quarried. I / We also agree to pay in advance any surface rent or cesses that may be demanded of me / us. Yours faithfully, Place : (Signature of the Applicant) Date : * substituted by G.O. (Ms) No. 276 /68, dated 1..7..1968. (Note :- Applications made by the Kerala Mineral Development Corporation may be submitted to the Director of Mining and Geology, directly)
