FORM – G
[See rule 28(1) of the West Bengal Minor Minerals Rules, 2002]
Model Form of Application for Quarry Permit
(To be submitted in duplicate)
No. ______________________
Date _____________________
Initial of Receiving Officer.
Received ............................................................. at...................................................................... (place) on
.................................................(date).
To:
The District Authority
Dist. .....................................
Sir,
I/We request that a quarry permit under the West Bengal Minor Minerals Rules, 2002 be granted to
me/us.
A sum of Rs.300.00 being the fee in respect of this application is deposited (copy of challan enclosed).
The following particulars are given below :
i) Name of the applicant with full address :
ii) Profession or nature of business of the applicant :
iii) Clearance certificate for payment of mining dues :
iv) Written consent of the raiyats, if the lands from which minor
minerals is to be extracted are raiyati lands, for extraction of
minerals in favour of the applicant :
v) Mineral which the applicant intends to quarry :
vi) The details of the lands from which the minor mineral is to
be quarried, including a plan of the area :
vii) Quantity of minor mineral to be extracted :
viii) Period during which the minor mineral will be quarried :
ix) Particulars of the area —
a) already holds under mining lease/quarry permit by the applicant:
b) the applicant has already applied for but not granted:
c) being applied for simultaneously :
x) Financial resources of the applicant :
xi) A copy of Acknowledgement receipt of Mining Lease
Application :
I/We hereby declare that the particulars furnished above are correct and am/are ready to furnish any other
details, as may be required by you. I/We do hereby further declare that I/We shall adhere to the terms and
conditions as indicated in these rules and any other conditions imposed by the Issuing Authority.
Yours faithfully
Signature and designation of applicant
Place:
Date:
By order of the Governor,
J. SIRCAR
Principal Secretary to the Govt. of West Bengal
and
Secretary, Commerce and Industries Department