FORM D -1

(Receipt of Application for Reconnaissance Permit)

(See rule 4-A)

Government of

S.No.                                                                                              Dated

              Received the application with the following enclosures for a reconnaissance permit of Shri/Sarvashree................................ on ............ 20..... for ------------------- square kilometres of land located in village/Government Forest Taluq....................District for reconnaissance of---------------mineral/minerals.

Enclosures:

Place

Date