1
[FORM 53
(See sub-rule(1) of Rule 108-CC)
Application for Grant of Land unauthorisedly Occupied
1. Name of Applicant
2. Age of Applicant
3. Father's/Husband's name
4. Address of the Applicant
5. Occupation
6. Is He
(a) a member of the SC/ST
(b) landless
(c) insufficient holder/marginal farmer
7. Gross Annual income of the applicant
8. Particulars of the land under unauthorised District Village S.No. Ext. Use of
land
occupation by the applicant Taluk
Dry
Wet
Garden
Plantation
9. Particulars of the land under unauthorised District Village S.No. Ext. Use of
land
occupation by the applicant and applied for Taluk
regularisation.
Dry
Wet
Garden
Plantation
10. Since how long the land is under unauthorised
occupation.
11. Particulars of the land already owned by the State Taluk Sy.No. Ext.
applicant inside/outside the State & Dist. &
Village
12. The total holding of land by applicant
13. Particulars of TT Fine paid, if any, (Enclose a copy of
the receipt acknowledging payment made)
14. Whether there is a separate access to the
encroached land
15. Whether the situation of the encroached land is such
that it can be enjoyed independently
16. Particulars of the (sic) previously granted to the Extent Sy.No. Village Taluk
applicant (sic)y member of his/her family
Dry
Wet
Garden
Plantation
17. Whether any other member of the family of the Extent Sy.No. Village Taluk
applicant has encroached upon the Government land
and applied for its regularisation and if so, the
details thereof
Dry
Wet
Garden
Plantation
18. Whether the applicant or any member of his/her
family has previously applied for land and if so the
particulars of the endorsement if any, received
thereon
Certified that the particulars furnished above are true and correct to the best of my knowledge.
Place: Signature of the applicant
Date:
ACKNOWLEDGMENT
Registration No. Dated:
Received an application form Sri/Smt.......................................................... for
regularisation of unauthorised occupation of land in Sy. No............of
village.......................Taluk......................
Receiving Clerk in the Office with Seal
___________________
1. Forms 53 to 56 inserted by Notification No. RD 38 LGP 98-11, dated 6-11-1998 w.e.f 9-11-1998.