FORM OF APPLICATION FOR MINING LEASE (FOR MINOR MINERALS)
(VIDE RULE 4 OF THE MAHARASHTRA MINERAL EXTRACTION, VIDARBHA REGION ) RULES 1966

Recieved at
on the                                  th day of (Month)                          Datd:    /    /  

From,
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        To,
        The Collector, Amravati.
                    I beg to apply for mining lease for extraction  ____________________________    for the permission                         __________________________________ for the permission ______________________________ to                         _______________________.
            The required particulars are as under-
        1. (a) (i) Full Name :
                 (ii) Nationality :
                 (iii) Profession :
                 (iv) Residance of Applicant :
                 (v)   If he is an individual :
        2. (a)(i) If the applicant is a company /sindicate/ partnership/ private firm.
                (ii) His name :
                (iii) Native place of bussiness :
                (iv) Place of  corporation with required site no. and date:
        3.     Area applied for as quarry (in Acres) :
        4.     Sr. No. Part of   whole, its area (in Acres) :
        5.     Name of the village, settlement no and P.C. no. :
        6.     Name of  Taluka and  R.I.S. circle :
        7.     Fill description illustrated by a map
               A rough plan in triplicate showing accurately the situation,
               boundries and the area of the land in respect of which
               mining lease is required:
        8.    Full name of minor mineral which the applicant intends to extract :
        9.    Purpose for which extracted minor minerals are to be used:
        10.    The period for which the lease is required (years) :
        11.     The areas and minor minerals within
                  the state in respect of which the applicant
                  or any person in joint interest with, already
                  holds a mining lease, if any:
        12.     Certificate of the financial standings
                  of the applicant from Revenue Officer
                  not below the rank of Tahsildar of from
                  Banking Co.  in the state as defined in the
                  Banking Companies Act 1957 or a Co-op.
                  Bank ( regd. or deemed to regd.) under
                  Mah. Co-op. Society Act 1960:
        13.     Application fee of   Rs. _____________/-
        14.     Security deposit of Rs._____________/-
                  (Equal to 50% of the annual deed rent fixed or the lease)
                  Credited date of  Credit , with Chalan No.________ and head of A/c
                        I   undertake to abide all the managed conditions of the lease which may be imposed on under the ____________
                Rules 1966 and ammendment therein _________________________ there  to for time in force.

                                                                                                                        Yours faithfully
                                                                                                                _______________________