ULHASNAGAR MUNICIPAL CORPORATION CITIZEN FACILITATION CENTRE SUBJECT: CERTIFICATE OF AREA-AFFECTED IN THE ROAD WIDENING 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): Information of Property: Head Information Type of Property (Please Tick [?] as applicable) [ ] Land [ ] Building Name of original owner Property No. (Computerized) Town/City: Taluka: Survey/Block/Barrack No.: C.T.S. No.: Part No./Sheet No.: Plot No./Unit No.: Area of Land (sq.mtr.) Road/Street/Lane: Ward Committee No.: 1 [ ] 2 [ ] 3 [ ] 4 [ ] Citizen Identification Number Necessary Particulars about above service: Head Particulars 1 Outward number and date of letter given by UMC for acquiring land for road widening purpose. Date: No.: 2 Area of land acquired by UMC for road widening (Sq.Mtr) Necessary Enclosures related to above application are enclosed as under. (If enclosed tick [ ? ] or not enclosed tick [?] ) Enclosures Yes/No 1 Location map & certificate from the concerned Executive/Deputy Engineer of the Corporation for acquired land. [ ] Declaration I/We..................................................................................................state on solemn affirmation that the above information is true and correct with the best of my 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 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):
