2. Name of the permit holder.

3. Residence with complete address of the permit holder.

4. Date of application.

5. Date on which application was received by the Receiving Officer.

6. Situation and boundaries of the land.

7. The details of the area and the minerals in the State for which the applicant holds reconnaissance permit on the basis of information supplied by the permit holder.

8. Total area for which permit granted.

9.       (a) Number and date of grant of the permit.

(b) Date of execution of reconnaissance permit agreement.

10. The mineral or minerals for which reconnaissance permit has been granted.

11. Period for which granted.

12. Application fee paid.

13. Permit fee paid.

14. Amount of security deposit.

15. Particulars of disposal or refund of security deposit.

16. Date of application for prospecting licence or mining lease (if any).

17. Date(s) of expiry or relinquishment or cancellation of permit or grant of prospecting licence or mining lease.

18. Date of assignment or transfer of reconnaissance permit, if any, and name and Address of assignee or transferee.

19. Date (s) from which the area is available for regrant.

20. Remarks.

21.  Signature of the Officer.