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, District ^*

b) If married, name of husband or wife

Present address ^*

Permanent Address ^*

7. Name of Father (In Capital) ^*

8. Name of Mother (In Capital) ^*

11. House pass Number ^*

12. House pass year ^*

13. Exact Location/Area/Veng ^*

14. Name of Village Council (Name of village)

15. Clearly indicate name(s) and address(es) of immediate neighbour

a) South (Chhim lam) ^*

b) North (Hmar lam) ^*

c) West (Khawthlang lam) ^*

d) East (Khawchhak lam) ^*

18. Whether the following documents are kept ready for inspection?

19. Other Contact details:

a) Telephone Number ^*

b) Email ID

I hereby certify that all particulars and documents are true and correct. Any incorrect particulars furnished herein will invite cancellation even if allotment or settlement has been done (A chunga sawite khi a dik vek tih ka hriattir e. Thil dik lo tarla

Terms and Conditions: 1. I hereby certify that all particulars and documents are true and correct. Any incorrect particulars furnished herein will invite cancellation even if allotment or settlement has been done (A chunga sawite khi a dik vek tih ka hriattir e. Thil dik lo tarla

Application for Residential Land Settlement Certificate

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