LAND REVENUE AND SETTLEMENT DEPARTMENT, Government of Mizoram, India

1. Name in Capital (as appeared in EPIC or UID or PAN)

2. Date of birth

3.Place of birth

6. If married, name of husband or wife (in capital letters)

Present Address ^*

8. Permanent Address ^*

9. Name of Father (In Capitals)

10. Name of Mother (In Capitals)

13. Occupation. If Applicant is govenment servant, indicate name of Department and designation ^*

14. Exact Location/Area/Veng ^*

a) Survey No. ^*

b) Plot No. ^*

c) Purpose for use of land ^*

15. Name of Village Council (Name of village) ^*

Clearly indicate name(s) & address (es) of immediate neighbour:

(a) South (chhim lam)

(b) North (Hmar lam) ^*

(d) East (Khawchhak lam) ^*

21. Telephone number ^*

22. Email

23. Name (in capital) of head of applicant's family as per EPIC/PAN/UID (diltute chhungkaw puipa ber hming) ^*

24. If name of head of family not indicated, reasons (Chhungkaw pa ber hminga dil a nih loh chuan, a chhan tarlan tur a ni)

Application for Periodic Patta (Periodic Patta Dilna)