FORM D

Receipt of Applications for Prospecting Licence/Mining Lease or Renewals

(See rules 10(4) and 23(4)]

Government of                                                                               Dated

S.No.

              Received the application with the following enclosures for a prospecting licence/mining lease/ renewal of prospecting licence/ renewal of mining lease of Shri/ Sarvashree …… on …… 20 ……. for about …… hectare of land located in village/Govt. Forest Taluq ……. District for prospecting/mining ………… mineral/minerals.

Enclosures:

Place

Date