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Application Form For Offer Of Land For Setting Up CNG Station
Form is Closed
Photograph of the Applicant:
(File Size Must Be Not Greater Then 300KB)
Signature:
(File Size Must Be Not Greater Then 300KB)
A. Applicant Information :
1. Name of Applicant
2. Date of Birth
3. Age (as on date of application)
4. Father’s/Husband’s Name
5. Gender
Select Gender
Male
Female
Nationality
Marital Status
6. Contact Number
E-mail ID
7. Current Postal Address
1. Flat/House No
2. Building Name
3. Plot No.
4. Street Name
5. Locality
6. Landmark
7. City
8. State
9. Pin Code
8. Type of Applicant:
Select Type
Individual
Partnership/Limited Liability Partnership*
Private Limited
Registered Co-Operative/Consumer Societies
Organized Bodies
Type of Applicant:
Partnership:
Number of Partners
Partnership Deed
Type of Applicant:
Private Limited:
Number of Director
Certificate Of Incorporation
Type of Applicant:
Registered Co-Operative/Consumer Societies :
Number of Director
(File Size Must Be Not Greater Then 1MB)
Authority Letter and copy of resolution specifying name of the authorized person for making application
(File Size Must Be Not Greater Then 1MB)
Balance sheet (Last 3 Years)
(File Size Must Be Not Greater Then 1MB)
Type of Applicant:
Organized Bodies:
Number of Director
(File Size Must Be Not Greater Then 1MB)
Authority Letter and copy of resolution specifying name of the authorized person for making application
(File Size Must Be Not Greater Then 1MB)
Balance sheet (Last 3 Years)
(File Size Must Be Not Greater Then 1MB)
9. Aadhar Card (Front & Back)
10. Pan Card
11. Education Certificate
B. DETAILS OF OFFERED LAND :
1. Type of Land
Select Type of Land
Owned (As on date of Application)
Registered Leased (As on date of Application)
Agreement to Lease (As on date of Application)
2. Name of the Owner(s) of the Site
3. Relationship of land owner with the applicant
4. Preferred Model
Select Preferred Model
COCO
DODO
COCO(Mega)
5. Location of the Plot
6. Longitude/Latitude Coordinates of the Centre point of Plot
7. Address of the Plot
8. Specify The Relevent Information
8.1 Khasra/Gata/Kila Number
8.2 Khata Number
8.3 Khatauni Number
8.4 City Survey no. of plot & village
8.5 Area of the plot (In Sq mtrs)
8.6 Frontage available (In mtrs)
8.7 Depth of the plot (In mtrs)
8.8 Details of the surroundings (Indicate approx. Distance between the surroundings and plot boundary)
East
West
South
North
8.9 Availability of power connection
Yes
No
8.10 Availability of water connection
Yes
No
8.11 Encroachments, if any
8.12 Trees in the Plot (If Yes, No. of Trees)
Yes
No
8.13 Whether offered plot is situated on National highway
Yes
No
8.14 Details of any adjoining roads(main Road, service road etc,)
8.15 Any pathway crossing the land
8.16 Any high voltage transmission lines Near by,If yes distance from the plot: in mtrs
8.17 Nearest police station
8.18 Nearest fire station
8.19 Whether title of plot is clear, marketable and Undisputed
8.20 Whether land is, at any time, covered in Govt. Acquisition plan
8.21 Whether the owner has received any notice of any type from any statutory body/ Agency for the referred plot. If yes, details there of
9. Khewat/Khatauni/Jamabandi of the subject land certified by the Patwari
(File size must be not greater than 1 MB) )
10. Ownership Documents/Sale Deed/ Lease agreement or firm allotment letter issued by government/ semiGovernment bodies/ Registered Lease Deed/Agreement to Lease for the proposed land with a lock-in period of minimum 30 years:
(File size must be not greater than 1 MB)
11. Mutation Records Jamabandi for last 20 years:
(File size must be not greater than 1 MB)
12. Land Feasibility Report:
(File size must be not greater than 1 MB)
13. GA (Geographical Areas)
Select Geographical Areas
14. Stretches
Select Stretches
15. Land Use
Select Land Use
Agriculture
Commercial
Industrial
Residential
Other
16. Layout plan superimposed on Naksha shijra(Signed by Owner)
(File size must be not greater than 1 MB)
C. PAYMENT DETAILS :
Payment Mode:
Select Payment Mode
Online
Offline
1. Application Fee Details:
Offline Payment Detail:
Bank Name
DD No
DD Date
DD Copy:
(File Size Must Be Not Greater Then 1MB)
2. Application Fee Details:
Online Payment Detail:
Account Name
Transaction ID
Transaction Date
Screenshot of Online Payment Confirmation:
(File Size Must Be Not Greater Then 1MB)
Click Here for IGL Account details for online payment
D. AFFIDAVIT / UNDERTAKINGS :
1. Undertaking for Character and Medical Conditions:
(File Size Must Be Not Greater Then 1MB)
2. Undertaking for the Proposed area:
(File Size Must Be Not Greater Then 1MB)
3. Undertaking for CLU:
(File Size Must Be Not Greater Then 1MB)
4. Status of Litigation:
(File Size Must Be Not Greater Then 1MB)
5. Leased Land/Owned Land Indemnification Affidavit by Applicant:
(File Size Must Be Not Greater Then 1MB)
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