APPENDIX   'A'

(SPECIMEN FORM OF APPLICATION)

                The Deputy Commissioner

               Papum Pare  District

                Yupia.

Through the circle Officier/EAC    …………………………………………………………………………….

Subject :- Request for Issue of Land Procession Certificate.

                I Shri/Smti…………………………………………………………of village………………………………Son of………………………………………………………………..Circle / Sub-Divn……………………………………...of …………………………………………………..District, do hereby request that a possession of Land may please be issued in my fevour for the purpose of………………………………………….

                The following is the description of my land for which I am Appling for a Possession Certificate.

DESCRIPTION OF LAND

I. Area……………………………….Sq. Mtrs…………………………………………………….

II. In the East

III. In West

IV. In the Nrth

V. In the South