ULHASNAGAR MUNICIPAL CORPORATION CITIZEN FACILITATION CENTRE SUBJECT: PERMISSION FOR CUTTING & TRIMMING HAZARDOUS TREE Token Number (For Office Use) Date:- / / (If Citizen Identification Number is given, do not fill below Details) Applicant's Details: Last Name/ Surname Name Father/Husband's Name Details of Society (If Application from Society): Name Of Society: Designation Address: Head Information House/Building/Soc. Name: Flat/Block/Barrack No.: Wing/Floor: Road/Street/Lane: Area/Locality/Town/City: Taluka: Pin code: Ward Committee No.: 1 [ ] 2 [ ] 3 [ ] 4 [ ] Electrol Panel No.: Telephone No. (if any): Contact Person: Email Address (if any): Necessary Particulars about above service: Head Information 1 Type of permission (Tick [ ? ] whichever is applicable) [ ] Cutting of hazardous tree [ ] Trimming of hazardous tree 2 Address of the place (where tree is to be cut/trimmed ) Pin 3 Owner of Tree- (Tick [?] which ever is applicable) [ ] Self [ ] Others 4 Type of other owners (Tick [?] which ever is applicable) [ ] Corporation [ ] Personal [ ] Joint/society/common 5 Name/type of the tree Citizen Identification Number 6 Reason for cutting the tree - (Tick [?] which ever is applicable) [ ] Due to Desiccated /dried tree (Dead tree) [ ] Due to virus infection [ ] Due to weak / feeble tree [ ] Due to spread out of tree [ ] Due to Electric wire passing from the tree [ ] Falling of trees due to storm [ ] Falling risk to lives/ property [ ] Obstacles in traffic Necessary Enclosures related to above application are enclosed as under. (Please tick [? ] for YES or tick [?] for NO) Enclosures Yes/No 1 Location map of place [ ] 2 NOC from owner of the tree (if owner is other than applicant) [ ] Declaration I/We................................................................................................. state on solemn affirmation that the above information is true and correct to the best of my/our knowledge. If the information given is found wrong then I/We shall be held legally liable for its consequences. Date:- Applicant's Signature ( ) The document may please be delivered to: 1. Self/Nominated Person [ ] a) C.F.C. [ ] b) Camp No. [ ] Name of Nominated Person (________________________________________________) 2. By Post a) U.P.C. [ ] b) Register A.D. [ ] 3. Courier [ ] (Not to be filled if address is same as above) Correspondence Address: - Last Name/ Surname Name Father/Husband's Name House/Building/Soc. Name: Flat/Block/Barrack No.: Wing/Floor: Road/Street/Lane: Area/Locality/Town/City: Taluka: Pin code: Email Address (if any):
