Meeseva Revenue Extract Of ORC Application Form

Meeseva Revenue Extract Of ORC Application Form
EXTRACT Applicant Details:-
Aadhar Number: _____________________________
Father Name*: _____________________________________
Mandal*: _________________________________
Locality/Landmark: __________________________________________
Survey Number*: ____________________________
Sub Division No.*: ______________________
Date of File/Reference: _____________________
Purpose for Extract of ORC*: ___________________________________________________
_________________________________________________________________
___________________________________________________
Informant Details:-
Informant Name*: ________________________
Mobile No.*: _____________________________
Delivery Type*:
At Kiosk
Post Local
Post Non
Postal Details: -
(Note: Please Upload Only in PDF Format)
District*: ____________________________________
Village/Ward*: ________________________________________
Pin code: _____________________________
Documents List: -
Application Form*
Copy of ORC (*- Indicates Mandatory) : ____________________
____________
_______________ (DD/MM/YYYY)
_________________________________________________________________
__________________________________
___________________________________________________
___________________________________________________
_______________________
_________________________________________________
_______________
___________________________________________________
____________________
_______________________
_______________________Informant Relation: __________________________________
Email ID: ______________________________________
_______________________
Post Non-Local
(Note: Please Upload Only in PDF Format)
__________________________
__________________ Mandal
*
: ____________________________
____________________
_________ Door No*: _______________________________________
_______________
___________

Applicant’s Signature