Application form for Prospecting license : FORM -B To be submitted in triplicate Received at ---------------------------- (place) on Date------------------------------------- Initial of Receiving Officer------------------------------------- GOVERNMENT OF UTTAR PRADESH MODEL FORM APPLICATION FOR PROSPECTING LICENSE SEE RULE 9 (I) To,....................Dated...... District Magistrate Sir, Through: I/We request that the prospecting license under the Mineral concession Rules, 1960 be granted to me/us. 2. A sum of Rs. .....being the fee in respect of this application at the rate of Rs. .....for the first square kilometer or part there of and Rs. .... for subset went square kilometer or part there of payable in accordance with schedule II to the Mineral Concession Rules 1960 has been deposited. 3. The required particulars are given below: (I) Name of the applicant wit complete address: (II) Is the applicant a private In case applicant is (a) An individual, his nationality: (b)A private company, the national- Laity of all members of the Company along with place of Registration. (c) A public company the national- Laity of directors, the percentage Of share capital held by Indian Nationals along with place of Incorporation. (d)A firm or association the nationality Of all partners of the firm or members Of the association. (iv) Profession of Nature of Business of the applicant. (v) (omitted) (vi) (a) No. & date of the valid clearance certificate of payment of mining dues ( copy attached) VI-b) If on the date of application The applicant does not hold A prospecting license, if Should be stated whet her an Affidavit to this effect has Been furnished to the Satisfaction of the state Government. (No. 1 (34)/ 68- MV I, dated 23 May 1970, GSR No. 1117, Dated 1st August 1970) VII) Mineral of minerals which The applicant intends to prospect. VIII) Period for which the prospecting License is required. : IX) Extent of the area the applicant Wants to prospect: X) Details of the area in respect Which prospecting license is Required. : District Taluka Village Khasra No/ plot No. Area X-a) Does the applicant have surface Rights over the area for which He requires a prospecting license: X-b) If not, has he obtained the consent Of the owner of and occupier of The land for undertaking prospecting Operations, If so, the consent of the Owner and the occupier obtained in writing Be field. XI. Brief description of the area With particular reference to the Following.: a) The situation of the area in the Respect of natural features Such as streams etc. b) In the case of village areas The name of the village and if Only a part of the village is Applied for, the Khasra No. the Area in hectares of each field Or part there of applied for. The areas shall cover whole or Recognized part survey numbers. In case of forest areas, the name Of the working circle, the range And the felling series. For areas where no forest maps or Cadastral maps are available, a Sketch plan should be submitted On scale showing the area applied For together with boundary If any, of any other existing Mining lease or prospecting License area if the area applied For case any common point or line With the boundaries of existing Prospecting License of mining Lease areas. XI) The area applied for should be Marked on plans as detailed below: a) In case a cadastral map of the area is available, the area on this map should be marked showing the name of the village, khasra No. and area is hectares of each field and part there of: XII) The area applied for shall cover whole survey numbers. b) In the case of the forest maps, the area should be marked on the map showing the range and felling series. c) In case neither cadastral nor forest maps are available the area should be marked on a sketch plan drawn to scale the dimensions of the lines forming this boundary of the area and the bearing and distance of all corner points from any importance prominent and fixed point or points. XIII) An affidavit that the up to date Income tax return, as prescribed under the Income tax A Ct 1961, have been filled and the tax due including the tax on account of self-assessment has been paid. XIV) Particulars of the areas mineral wise ( in each state duly supported by an affidavit) for which the applicant or any person joint in interest with him. a) already holds under prospecting License. b) has already applied for but not granted, or. c) being applied for simile tenuously. XV) Nature of joint in interest, if any XVI) If the applicant intends to supervise the works, his previous experience of prospecting and mining should be explained, if he intends to appoint a Manager, the name of such manager, his qualification, nature and extend of his previous experience should be specified and his consent letter should be attached. XVII) Financial resources of the applicant. XVIII) Particulars of receipted treasury challis attached for the amount referred to at 2 above. XIX) Any other particulars or sketch map which the applicant wishes to furnish. I/We do hereby declare that the particulars furnished above are correct and am/are ready to furnish any other details including accurate plans as may be required by you. Place : Yours faithfully, Dated : Signature and designation of the applicant.
