1. No category

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Single Window Clearance System
FORM A
[See rule­9(1)]
APPLICATION FOR CONVERSION OF AGRICULTURAL LAND FOR NON­AGRICULTURAL
PURPOSE
To
The Prescribed Authority
(State Government/
District Collector/
Sub­Divisional officer
/Tehsildar)
NADBAI­ BHARATPUR
Sir,
I/We SHIV MAHIMA MILK PRODUCTS P LTD hereby apply under rule 9 of the Rajasthan Land Revenue
(Conversion of Agricultural Land for Non­Agricultural purposes in Rural Areas)Rules,2007 for the conversion of agricultural
land held in my/our khatedari tenancy for non­agricultural purpose,the particulars where of are given here/under:
1. Name/Names of khatedar tenant with father's/husband's name and Address Khatedar Name
Address
Father/husband name
SHIV MAHIMA MILK
PRODUCTS P LTD
D­6/403, CHITRAKOOT, JAIPUR
BHARAT MITTAL
2. Whether the applicant is a member of SC or ST
3. Details of the land sought to be converted:
No
(a) Name of the village
Name of the Gram Panchayat
Name of the Tehsil
(b) Whether the land is situated in any peripheral belt or within the local area of a Municipal
/Corporation/Council/Board.
(c) Khasra No./Nos. of the land alongwith total area of each khasra No.
Khasra No.
Total Area
534
0.37
535
0.25
536
0.30
537
0.37
496
0.37
497
0.30
SHAHPUR
LAKHANPUR
NADBAI
No
Note: Enclose two certified copies of the latest Jamabandi.
4 Area(in hectare or sq.mt)applied for conversion,indicating the exact location of such area in the map.(Note: Enclose two
certified copies of the relevant part of the revenue map,showing the land sought to be converted in red ink.) Area 1.96 OR 19600 SQ MTR (in hectare or sq.
mt)
Location PHERSAL MODE, NEAR DHERA
MODE, NH11
DAIRY MILK PRODUCTS
No
5. Purpose of conversion
6. Whether the land is covered by Urban Land(Ceiling and
Regulation)Act,1976.
7. Whether the land is declared surplus under the Rajasthan Imposition of No
Ceiling on Agricultural Holdings Act;1973 or under the repealed Chepter
IIIB of the Rajasthan Tenancy Act,1955.
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8. Whether the land is under acquisition under the Land Acquisition
No
Act,1894.
9. Whether the land was alloted to the applicant by the State Govt. for any No
specific purpose.If so,give the No. and date of the order.
No.
Date:
10. Land use shown in the Master Plan,if applicable.
11. Distance from the Railway line,National Highway,State Highway or any
600 in meters
other road or rural path way(in meters.).
12. Distance from the outer limit of the abadi of a village in case of
500 MTR
individual purpose.
13. Whether the application is submitted under rule 13 for regularization of Yes
the construction made prior to coming into force of these Rules.
14. Rate of conversion charges payable.
N/A
15. No. and date of the challan making the payment of the conversion (Note:Enclose original/copy of the challan.). No: Date:
16. Any other information.
N/A
I/We hereby certify that the above particulars are correct according to my/our knowledge and belief.
Yours faithfully,
Place: JAIPUR
Signatures of Applicant
Date: 09/07/2013
Receipt No
Received the application from Shri for conversion of khasra No.
in village
to­day i.e Place:
Date:
Signature:
Prescribed Authority
(The State Government/District
Collector/SDO/Tehsildar)
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