Form - A

Information of Land intended for leasing out to developers for setting up of Solar Power Plant under component of PM-KUSUM Scheme

All (*) marked fields are mandatory to be filled.

A. General Information

i. Name of the land owner as per land record *

ii. Name of the legitimate legal heir of the land in case of demise of original owner *

iii. Type of land *

iv. Name of owners of four bordering lands: (mention NA wherever not applicable)

a. Eastern Side

b. Western Side

c. Northern Side

d. Southern Side

Details of Contact

v. Name of Authorised Person (with power of attorney) *

Please upload Power of attorney *

Choose File

Postal Address *

PIN *

Mobile No. *

Whatsapp No.

Email ID

B. Details of Land

i. Total area of the land (in Bigha) *

ii. Area proposed for leasing for PM-KUSUM (in Bigha) *

iii. District *

iv. Revenue Circle *

v. Block *

vi. Panchayat / VCDC *

vii. Village *

C. Concerned APDCL offices

i. Electrical Circle *

ii. Concerned 33/11 kV Sub-Station *

The information submitted above are true to the best of my knowledge and belief and no related information is/are concealed.

It is to undertake that the land mentioned herein above is/are under absolute possession of the undersigned and no litigation is pending before any forum.

It is also to undertake that the undersigned will be leaglly bound to compensate all damages caused in the event of anything of the aforementioned proven false at a subsequent date without any conditionality.

Date :

Full name :

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