SCHEUDULE - 1
(See Rule 3)
FORM OF APPLICATION UNDER SUB-SECTION(1) OF SECTION 32 OF THE GOA,DAMAN AND DIU
LAND REVENUE CODE - 1968

* Full Name:  
* Address:  

a) Assessed or held for the purpose of agriculture for the non-agricultural purpose/purposes for :  
b) Assessed or held for the Non-Agriculture purpose of :   For the Non-Agricultural purpose/purposes of :  
c) Assessed or held for the Non-Agriculture purpose of:   for the same purpose but in relaxation of condition:  
imposed at The time of grant of land or permission for non-agricultural use viz:  

* Full postal address :   Same as above

* Occupation :  


Area of the site of (5) above proposed to be use for the purpose of :

* Occupant Type :
Applied for Re-application ? :