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E-Pass Book

The document is an application form for obtaining a Pattadhar Pass Book, which can be a new issue, duplicate, or replacement. It requires details about land, pattadhar, and the applicant, along with specific documents based on the service type. The form also includes sections for personal and contact information, as well as delivery preferences.

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Sachivalyam Chitvel2
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82 views2 pages

E-Pass Book

The document is an application form for obtaining a Pattadhar Pass Book, which can be a new issue, duplicate, or replacement. It requires details about land, pattadhar, and the applicant, along with specific documents based on the service type. The form also includes sections for personal and contact information, as well as delivery preferences.

Uploaded by

Sachivalyam Chitvel2
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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E-Pass Book Application Form

Service Type*: New Pattadhar Pass Book


 Duplicate Pattadhar Pass Book
 Replacement of Pattadhar Pass Book

Land Details:-

District *: _________________Mandal *: ___________________Village*: ________________ Khata No*: ________

Pattadhar Details:-

Caste Category *: _________________Caste Name *: __________________Division Name*: _______________


Reasons for Pattadhar Pass Book*: ______________________________________________________________________
For Duplicate/Replacement of Pattadhar Pass Book
Old Pattadhar Pass BookNo *: _________________Registration No *: __________________Registration Date*: ________

Applicant Details:-

Applicant Name *: ______________________________Relation *: _________________________Gender*: _________


Date of Birth: _____________________

Permanent Address:-

State*: ____________________Door No: _________________ Locality/Land Mark: ____________________________

District*: ____________________ Mandal*: _____________ Village/Ward*: _________________Pin Code: _________

Address to send the e-passbook:-

Door No: _________________ Locality/Land Mark: _______________________________________________

State*:_____________________District*: _________________________ Mandal*: ____________________

Village/Ward*: ____________________Pin Code: _________________Mobile Number*: __________________

Phone: ___________________Email ID: _________________Ration Card No: ___________________

Remarks: ___________________________________________________________________________________

Delivery Type*:  Postal


Document List: - (NOTE: All Upload Documents are in PDF format only and All Documents Size must not exceed 3MB )

For New Pattadhar Pass Book:


 Application Form *
 Tax receipts if any *
 Old Pattadar Passbook *
 Registered document (copies) *
 Buyer Recent passport size photo * (In .JPG Format Only)
 Buyer Signature * (In .JPG Format Only)

For Duplicate Pattadhar Pass Book:


 Application form *
 Scanned Copy FIR*
 NOC certificate from the bank in the respective jurisdiction *
 Registered Document (Copies) if any*
 Recent pass port Size photo*(In .JPG Format Only)
 Signature * (In .JPG Format Only)

For Replacement Pattadhar Pass Book:


 Application form*
 Registered Document (Copies) if any*
 Recent pass port Size photo*(In .JPG Format Only)
 Signature* (In .JPG Format Only)

Applicant’s Signature

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