APPENDIX – I
FORM B
(See Rule 4.1)
The Tree Officer,
…………………………………………….
Sir,
I apply for grant of permission for felling trees located in the property situated in the village
Taluka…………………………and District……………………………...I furnish below the following details in
support of my application:-
i) Applicant’s name and address (In block letters)
ii) Name and address of the owner of the property (if different from applicant)
iii) Title of the applicant i.e. whether owner/occupant of the property, etc.
iv) Name and serial number of property
v) Total area of the property with description of the boundaries
vi) Total number of trees (species-wise) whose trunk or body is not less than 5 cm. in
diameter at a height of 30 cms. from the ground and whose height is not less than one
meter from the ground
vii) The exact area (in sq. meters) from which felling of trees for which permit is sought
(description of the boundaries)
viii) Total number of trees to be felled
ix) Trees to be felled are numerically numbered in paint, their girth measured at a height
of 1.35 meters from ground level and their details species wise
x) Purpose for which the felling of trees are intended
xi) Intended use of felled trees (e.g. for sale, for domestic use, etc.)
xii) Intended use of land after felling of trees
xiii) Number and species of trees intended to be planted after felling (give details of
arrangement for raising, planting and protecting trees)
xiv) Names and addresses of the owners/occupants adjoining properties
2. I am enclosing an affidavit and below mentioned papers in support of my application.
Declaration
I hereby declare that I shall fully satisfy and abide by such terms and conditions of
the permit as may be specified therein.
Place:-
Date:-
APPLICANT’S SIGNATURE
Attested copies of:-
1. Property/Occupancy documents.
2. Plan of the property showing the survey number.
3. Enumeration list (duly signed by the applicant).
4. Boundary list (duly signed by the applicant).
5. Latest index of land record issued by the Mamlatdar.
6. N.O.C. from Administrator of Communidade.
7. N.O.C from adjoining property owners:
Affidavit
(To be signed on a stamped paper in the presence of Magistrate or authority approved for the
purpose)
I,……………, aged……………..year, resident of………………..(locality).………….village, ……….…………. Taluka,
………………….Goa District, wife/son/daughter of ………………….do hereby solemnly affirm and declare
as under:
1. That I am the legal owner/occupant of the private property known as “……………” situated at
………………..Village…………………….Taluka bearing cadastral survey number………………………of,
boundaries of which are as follows:-
East:
West:
North:
South:
2. That I have applied to the Tree Officer…………………………………..for permission to fell………………..
(number) trees from the aforesaid property. All the trees have been numbered with paint.
3. That there is no other owner/occupant of this property or of the forest produce of this property
and I hereby solemnly affirm and declare that I shall be solely responsible and answerable for
any claim and litigation, if any, that may arise at any time in future regarding the
ownership/occupancy of the said property or the forest produce from the said property.
4. I hereby solemnly declare and affirm that to the best of my knowledge and belief the information
is correct and true and nothing material has been concealed and is false.
Place:
Date:
DEPONENT
APPENDIX – II
FORM C
[See Rule 4 (2)]
To,
The Tree Officer and
……………………………………………….
……………………………………………….
Sir,
I apply for grant of permission for removal and disposal of trees located in the property
situated in the village…………………….Taluka…………………………and District……………………I furnish
below the details in support of my application:-
i) Applicant’s name and address (in block letters)
ii) Name and address of the owner of the property
(if different from applicant) from which trees
were felled.
iii) Title of the applicant i.e. whether
owner/occupant of the property etc. from
which trees were felled.
iv) Name and serial number of the property from
Which trees were felled.
v) Total area of the property with description of
the boundaries.
vi) Total number of felled trees (species-wise)
whose trunk or body is not less than 5 cm. in
diameter at a height 30cm. from the ground and
whose height was not less one meter from the
ground.
vii) Describe the circumstances under which the
tree/s was/were felled i.e. whether the tree/(s)
was/were felled after obtaining the permit (a
copy of the permit is to be enclosed) or under
the provision to section 8 of the Ordinance or
had fallen due to natural causes, etc.
viii) Details of material obtained from the felled tree.
First class timber… cu.m.
Second class matti… cu.m.
Second class timber… cu.m.
Third class timber… cu.m.
Firewood… cu.m.
First class Poles… Nos.
Second class poles... Nos.
Third class Poles… Nos.
ix) The manner in which the material would be
removed i.e. by road, rail, waterways and the
mode of transport.
x) Transit route.
xi) Removal of the material completed by (date).
xii) The material is intended to be disposed in the
manner indicated below:-
a) For self use
Quantity
First class timber… cu.m.
Second class metti… cu.m.
Second class (other)… cu.m.
Third class timber… cu.m.
Firewood… cu.m.
First class Poles… Nos.
Second class Poles… Nos.
Third class Poles… Nos.
b) By sale
Quantity
First class timber… cu.m.
Second class matti… cu.m.
Second class (other)… cu.m.
Third class timber… cu.m.
Firewood… cu.m.
First class Poles… Nos.
Second class Poles… Nos.
Third class Poles… Nos.
c) Name(s) and full Address/es of the
persons/parties to whom the
material would be disposed by sale.
d) Licence number of the purchaser (if
purchaser is holder of a licence
issued by Forest Department).
I am enclosing below mentioned papers in support of my application.
Declaration
I hereby declare that I shall fully satisfy and abide by such terms and conditions of the permit as
may be specified therein.
Place:-
Date:-
APPLICANT’S SINGNATURE
Attested Copies of:-
a) Property/Occupancy documents.
b) Plan of the property showing the survey number.
c) Boundary list (duly signed by the applicant)
d) Latest Index of Land record issued by the Mamlatdar.
e) Report, if any, made pursuant to provision to section 8 of the Ordinance.
f) Permit, if any, granted by the Tree officer.
APPENDIX –III
FORM A
( See rule 3)
The Tree Officer,
………………………………
Sir,
I have to report that I have felled on ………(date) at ………(time) .……(number)/tree from the
property owned by me/under my occupation in the village ……Taluka………and District… I declare
that if the said tree/s had not been immediately felled, it/they would have posed grave danger to
life/property/ traffic (delete inapplicable words).
2. The following details are furnished: -
i. Name and full address of the signatory (In
Block letters).
ii. Title in respect of land in which tree(s)
was/were situated.
iii. Location of the site from which tree/s felled
(give name and survey number of plot and
indicate as clearly as possible the actual
situation of the tree)
iv. a) Species of the tree felled
b) Its approximate age
c) Its girth measured at a height of 1.35
meters from ground level.
v. Justification for felling the tree/trees (Here
describe the way in which the tree posed
danger and the reasons why you could not
wait to seek permission for cutting it).
SIGNATURE
Place: -
Date:
