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    Utkal kumar Patra
    This document is an application form for obtaining a certified copy of records of rights (ROR) from land records. It contains fields for applicant personal details like name, address, father's name, contact information. It also contains fields for details of the required ROR like district, tahsil, police station, village, survey number, plot number, area, crop etc. The applicant needs to provide identity documents and pay applicable government fees and service charges to private operators for processing the application within an estimated timeline of 3 working days. The applicant signs declaring that all information provided is true to their knowledge.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    25 PDF

    Uploaded by

    Utkal kumar Patra
    194 views2 pages
    This document is an application form for obtaining a certified copy of records of rights (ROR) from land records. It contains fields for applicant personal details like name, address, father's name, contact information. It also contains fields for details of the required ROR like district, tahsil, police station, village, survey number, plot number, area, crop etc. The applicant needs to provide identity documents and pay applicable government fees and service charges to private operators for processing the application within an estimated timeline of 3 working days. The applicant signs declaring that all information provided is true to their knowledge.

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    This document is an application form for obtaining a certified copy of records of rights (ROR) from land records. It contains fields for applicant personal details like name, address, father's name, contact information. It also contains fields for details of the required ROR like district, tahsil, police station, village, survey number, plot number, area, crop etc. The applicant needs to provide identity documents and pay applicable government fees and service charges to private operators for processing the application within an estimated timeline of 3 working days. The applicant signs declaring that all information provided is true to their knowledge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    194 views2 pages

    25 PDF

    Uploaded by

    Utkal kumar Patra
    This document is an application form for obtaining a certified copy of records of rights (ROR) from land records. It contains fields for applicant personal details like name, address, father's name, contact information. It also contains fields for details of the required ROR like district, tahsil, police station, village, survey number, plot number, area, crop etc. The applicant needs to provide identity documents and pay applicable government fees and service charges to private operators for processing the application within an estimated timeline of 3 working days. The applicant signs declaring that all information provided is true to their knowledge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Court Fee Stamp as required

    APPLICATION FORM FOR CERTIFY COPY OF ROR

    (Fields marked * are mandatory)


    Paste Applicant
    Photo
    Service Payment Details :
    1. Kiosk Operator charges = 10.00
    2.Printing Charges per unit = 10.00
    3.Scanning Charges per unit = 5.00
    4.The Government fees per unit = 50.00
    5.DeGs Charges per unit = 10.00

    (The amount may vary based on no of printing and scaning page counts)
    The Acknowledgement of receipt of Application / Delivery of Certificate and
    Payments received from the citizens shall be issued free of cost by the CSC operator to the citizens
    (The amount may vary based on no of printing and scaning page counts)
    Documents Required Applicant’s signatutre / Thumb Impression
    Mandatory Documents
    Supporting Documents 1. Land Records
    2. Any other document in support/claim
    Delivery Time Lines ; Estimated Timelines To Process The Application (Expected Date of Delivery) : 3 working Days

    Fill all the details in the block letters


    Personal Details
    Applicant Name* :- ___________________ ___________________ ___________________
    Gender* :- ___________________ Marital Status*:- ___________________
    Date of Birth* :- ___________________ Age* :- ___________________
    Parents Details
    Father Name* :- ___________________ ___________________ ___________________
    Mother Name*
    :- ___________________ ___________________ _______________
    Spouse Details
    Spouse Name* :- ___________________ ___________________ ___________________
    Relation With Applicant* :- ___________________
    Contact Details
    Phone No :- ___________________ Mobile No :- __________________
    Email :- ___________________
    Permanent Address
    District * :- _____________________ Sub Division * :- ___________________________
    Tahsil * :- __________________ RI Circle * :- ________________________
    Block * :- ____________________
    GP/ULB :- ______________ Village / Ward* :- _____________________________________________
    House No/Street Name :- ________________________ Post Office :- _________________________
    Police Station * :- __________________ Pin :- ________________________
    Submitter Details
    Is applicant and submitter are same? * Yes No
    Submitter's Name* :- ___________________ ___________________ ___________________
    Relation With Applicant* :- ___________________
    Present Address
    Is Present Address Same as Permanent Address? Yes No
    (If "No" please fill the Present address given below)
    District * :- _____________________ Sub Division * :- ___________________________
    Tahsil * :- __________________ RI Circle * :- ________________________
    Block * :- ____________________
    GP/ULB :- ______________ Village / Ward* :- _____________________________________________
    House No/Street Name :- ________________________ Post Office :- _________________________
    Police Station * :- ________________________ Pin :- ________________________

    Details of ROR for which is Certified Copy is Required:-


    District* :- ___________________ Sub Division * :- __________________
    Tahsil * :- ___________________ RI Circle * :- _________________
    Police Station * :- ___________________ Mouza(Revenue Village) * :- __________________
    Khata No * :- ___________________ Recorded Tenant (Land Owner) *:- __________________
    Relation of the applicant with Recorded
    Tenant * :- _______________________________________________________________________
    Sl No. Plot No * Area * Kisam *
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10

    Plot Details:-

    Caste :- _------------------------------------------- Tribe __ :- ------------------------------------------


    Mandatory Fields
    Purpose * :- _______________________ ___________________ ___________________ ___________________

    I, Shri / Smt …………………………………….….Son of / Daughter of / Wife of ………………………………………………resident


    of village ……………………………………..…. P.S. …………..…………………… District ……………………..………… and
    particulars stated above are true to the best of my knowledge and belief and that they are exhaustive and I have not suppressed any fact.
    In case it is detected later on that any of the facts stated herein wrong or that I have suppressed some material facts, I shall be liable for
    prosecution under the relevant law.

    Signature of the applicant.

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