FORM A

(See Rules 5, 10 and 13)

Received at (Place)................................................................................ .
On (date).................................................................................................
at (hour) ................................................................................................ ..
Initials of Receiving officer ......................................................................
Application for Quarrying Permit
(For all types of lands)
To be submitted in Triplicate

From

To

The Geologist
District Office of the Dept. of
Mining & Geology,
.................. District.

Sir,

I/We request that a quarrying permit under the Kerala Minor Mineral Can
cession Rules 1967 may be granted to me/us.

2. A sum of Rs. 200 being the fee in respect of this application payable under
rule 6 of the said rules has been deposited;

3. The required particulars are given below:

(i) Name & complete address of the applicant.
(ii) Is the applicant a private individual/private
company/public company/firm or associ
ation.
(iii). In case applicant is,
(a) an individual, his nationality
(b) a private company, the names & natio-
nality of all members and place of
registration.
(c) a public company, the names and natio-
nality of the Directors, the percentage
of share capital held by Indian Natio-
nals and place of incorporation.
(d) firm or association; the names and
nationality of all the particulars of the
 firm or members of the association and
place of registration.

(iv) Profession or nature of business of the

applicant.

(v) Name/Names of the minor mineral/mine-

rals to be quarried.

(vi) Quantity of the minor mineral/minerals for

which permit is required

(vii) Full description of the land from which the mineral District
is to be quarried an attested copy of a survey map of the Taluk
Panchayat
area showing survey Nos. Boundary Nos.etc.
Village
should be submitted. The area should be coloured in Survey no
red-vide sub rule (2) rule (5) Area

(viii) Particulars of the documents showing natu-

re of tenure of the land and ownership of the
land.

(ix) Details of consent letter from the land owner permitting surface operation.

(x) Purpose for which the minor mineral is to be used.

4. Particulars of the receipted treasury chalan

attached for the amount referred to at 2 above.

5. I/We do hereby declare that the particulars furnished above are correct and
am/are ready to furnish any other details as may be required by you. I/we agree
to pay the advance the royalty that may be assessed on the quantity of
mineral(s) is proposed to be quarried. I/we also agree to pay in advance any
surface rent or cesses that may be demanded of me/us.

Yours faithfully,

(Signature of the Applicant)

Place:
Date:

[Note:- Applications made by the Kerala Mineral Development Corporation may

be submitted to the Director of Mining and Geology, direct].