Yes No Yes No Whether land is situated in any area Within one-half Km. on either side of National Highway/ One/ Fourth Km. On either side of State Highways, the details thereof. Published on National Portal of India (india.gov.in) Government of Orissa Department of Agriculture Application Form for Raiyat for Conversion of Agricultural Land for non- Agricultural Purposes (See rule 12-A (1) (a) ) FORM No. 25 To The Authorised Officer 1.Name of the Raiyat 2. Father's / Husband's Name 3.Address 4.Specific purpose for which the land Will be utilized after conversion. Particulars of land a. Holding Number b. Plot Number c. Area d.Classification and status as per Current R.O.R. e. Village with Thana Number f. Others, if any No Yes 1.Whether the land situated in a Muncipal/ N.A.C,/ Developing area/Rural area,If so The details thereof Date from which the land is intended To be used/already used for non-Agricultural purpose. 1.Source of ownership Rs /- 2.Approximate market value of the land Date : Signature of the Applicant Published on National Portal of India (india.gov.in)
