+GOVERNMBNT OF RAJASTHAN DEPARTMENT OF MINES & GEOLOGY, RAJSTHAN FORM No.

1-C Application for grant of Quarry License [See rule 22] To, The Mining Engineer/Assistant Mining Engineer, Department of Mines & Geology , Rajasthan, Sir, I/Werequest you to grant me/us quarry licence for mineral..over Plot No..in area for a period of.years under the Rajasthan Minor Mineral Concession Rules, 1986. 2. I have deposited Rs. .as the application fee payable under rule 23 vide demand draft/treasury Challan NoReceipt No..dated.. 3. Following are the required particulars: (A) (1) (2) (3) (4) (5) (B) 1. 2. 3. 4. N.B. In case the applicant is an individual Father's Name/Husband's Name Cast Occupation Nationality Permanent address In case the applicant is Firm/Company/Association/Society Kind of business Place of business Place of registration Nationality of Directors/Partners.

Please enclose copies of certificate of Firm's registration, partnership deed, power of attorney, Certificate of incorporation, Memorandum of Articles and Articles of Association and resolution of Board of Directors about applying for quarry licence. 1. Details of areas held by the applicant in Rajasthan (Mining leases or quarry licences already held).

S.No.

Name of Mineral for which Extent of area period of lease/

Location of

Division

lease/ quarry held (Give plot Quarry Licence licence is held Nos. of quarry from to licence 3 4 5 6

lease/ Quarry licence 7

1 5.

Details of Lease/Licence applied for simultaneously

1.. 2. 3.. 6. Category to which the applicant belongs (please attach necessary certificates) (i) (ii) (iii) (iv)
(v)

manual workers belonging to Scheduled Caste/Scheduled Tribes; Manual workers other than those belonging to Scheduled Caste/Scheduled Tribes, Village artisans & land less labourers; Persons belonging to Scheduled Caste/Scheduled Tribe other than those specified in category (I); Persons selected under "Integrated Rural Development Programme" of the State Government;
Village artisans and land-less labourers.

(vi)

Ex-soldiers including members of para-military forces belonging to Rajasthan who have been permanently disabled and dependents of those have been killed in action; State Government Servant who have been permanently disabled while on duty or the dependents of those Stte Government servants who have been killed on duty; and Persons from categories other than specified.

(vii)

(viii) 7.

Are you intending to set up a mineral based industry in the area using this mineral as raw material. (If so give particulars of the same)

I/We declare that particulars given above are correct and I / We will furnish any other details required in this connection on demand. Yours faithfully, (Signature.) Name : Present address: Place: Date: