1. Name in capital (as appeared in EPIC or UID or PAN) * 2. Date of Birth * 3. Place of Birth, District * 4. Present Address * 5. Permanent Address * 6. Name of Father (In Capitals) * 7. Name of Mother (In Capitals) * 8. Whether applicant belongs to a tribal (Mizo) as specified in sub-section (45) of section 2 of the Act * Select Yes No 9. If the applicant is not born in Mizoram, Do you enclose domicile certificate issued by Home Department? * Select Yes No 10. Exact Location/Area/Veng * 11. Indicate category: * Select Shop Stall 12. Name of Village Council (Name of Village) 13. Clearly indicate name(s) & Address(es) of immediate neighbour a) South (Chhim lam) * b) North (Hmar lamah) * c) West (Khawthlang lam) * d) East (Khawchhak lam) * 14. Whether area is cleared for easy movement of Surveyors? * Select Yes No 15. Whether 4 (Four Boundary) pillars as prescribed by Revenue Department are provided for fixing on the day of survey operation? * Select Yes No 16. Other contact details: a) Telephone number b) Email Note: Hemi Vengah hian a thenawmte hi an awm lo a nih pawhin a ram awmna hmun hi chipchiar takin ziah tur a ni (In case neighbours are not present, clear location of land should be described) Submit
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