LAND REVENUE AND SETTLEMENT DEPARTMENT, Government of Mizoram, India

1. Name of the Applicant ^*

2. Address of the Applicant (With Proof of Address) ^*

3. Status of the applicant [Individual/Registered Firm/Company registered under Companies Act,1956/ Co-operative Society/ Society under The Mizoram Societies Registration Act, 2005 or any other copy of such registration to be enclosed]

4. Name and addresses of Partner(s), Director(s)/Trustee(s) who will have managerial control over the operation of the firm/company/society/trust

5. Address/Area of Land/Site Applied for:

a) Area described in SQM and Bigha ^*

b) Description of area with boundary ^*

c) Village, District ^*

6. If land is already acquired,

b) Name and address from whom acquired

c) Nature of said land allotment/settlement

7. Purpose for which land is to be developed or deployed (diversion of use of land is strictly prohibited) in case project profille or report is prepared a certified copy may be submitted

8. Duration/period land is required [transfer of land is not permissible as per Rules]

a) If Yes give details

I am authorized to make application and submit necessary information/documents. I hereby declare that all particulars and information submitted herewith are true and correct to the best of my belief and knowledge.

Note: For Proof of Address, certified bank statement or cop of registration under government rules and regulation or telephone bill or power bill shall be accepted

Application for Submission Or Proposal Before Mizoram Public Investment Board (MPIB) in Revenue Dept. GoM

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