FORM-N

"To be submitted in triplicate"

Model Form of Application for Revision

(See rule 54)

1. Name and address of individual/s firm or company applying.

2. Profession of individual/s or firm or company.

3        (a) Number and date of order and authority passing the order against which revision                  application is filed;

(b) Date of communication of the order to the applicant.

4.       (a) If the application is in respect of deemed rejection, the date of receipt of the application                  for mineral concession, surrender or transfer by the State Govt.;

(b) If the application is in respect of an order made on an application for mineral       concession, specify -

(i) whether for grant or renewal;

(ii) whether for prospecting licence or for mining lease;

(iii) date of such application;

(iv) if for renewal, the number and date, of letter of the State Government conveying the grant and the date upto which licence/lease was granted;

(v) in the case of second or subsequent renewal, the number and date of letter of earlier grant (s) and date (s) upto which grant (s) have been made.

5. Mineral or minerals for which the revision application is filed.

6. Details of the area in respect of which the revision application is filed.

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District                        Taluk                    Village                    Khasra No.

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Total area claimed.

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(A map or plan of the area (s) to be attached.)

7. Whether application fee of Rs.500/- has been deposited in the manner prescribed in sub-rule (1) of rule 54 of the Mineral Concession Rules, 1960. If so, treasury receipt or bank draft in original should be attached.

8. Whether the revision application has been filed within (three months) of the date of communication of the order passed by the State Government.

9. If not, the reasons for not presenting it within the prescribed limit as provided for in proviso to sub-rule (1) of rule 54 of Mineral Concession Rules 1960.

10. Name and complete address of the party/parties impleaded [Sub- rule (2) of rule 54].

11. Number of copies of petition attached [Sub-rule (3) of rule 54].

12. Grounds of revision.

13. If the revision application has been filed by the holder of Power of Attorney, the Power of Attorney to be attached.

                                                                                                Yours faithfully,

Signature and designation of the applicant

Place