ABSTRACT

Sl. Service Name Form

No. No.
I. Revenue Section
1. Assessment/Re-assessment of PT 001
2. Assessment/Re-assessment of VLT 002
3. RP/GRP for PT 003
4. RP/GRP for VLT 004
5. Mutation (or) Transfer of Property 005
(Registration not done)
6 Mutation (or) Transfer of Property 006
(Registration already done)
7. PT exemption 007
8. Sub-division (or) Bifurcation of Property 008
9 Vacancy Remission 009
10. Amalgamation of Property 010
11. Demolition of Property 011
12 Ownership certificate 012
13. Valuation Certificate 013
II.Engineering Section
14. New/Additional Water Tap connection 014
15. Change of Usage of Water Tap connection 015
16. Closure of Water Tap connection 016
III. Public Health Section
17. New Trade License (Post approval time-line) 017
18. Renewal of License (Post approval time-line) 018
19. Change of name of the Trade 019
IV. Vital Statistics
20. Issuance of Birth Certificate 020
21. Child name inclusion in Birth Certificate (After 021
One year)
22. Child name inclusion in Birth Certificate (within 022
One year)
23. Name correction in Birth Certificate 023
24. Non-availability certificate for Birth Entry 024
25. Issuance of Death Certificate 025
26. Non-availability certificate for death entry 026
27. Sanitation Certificate (Manual System) 027
28. Application for Marriage Registration 028

1
 FORM – OO1
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR ASSESSMENT / RE-ASSESSMENT OF PROPERTY TAX

File No
(to be generated by CSC)

A. Owner Details:
Aadhar No. Mobile No. Owner Name Gender Email Guardian Name
Address (S/o, D/o, W/o)

B. Property Particulars:

1.Category of Private [ ] State Govt. [ ] Central Govt. [ ]

Ownership
2.Property Type Residential [ ] Non-Residential [ ] Mixed [ ]
3.Apartment / Complex
Name
4. Door No. (In case of
existing building)
5. Assessment No. (In
case of existing building)
6.Locality
7.Revenue Zone No.
8.Revenue Ward No.
9.Revenue Block No.
10.Street No.
11.Election Ward No.
12.Property Address

13.Pin Code
14.Amenities : 1. Lift [ ]
2. Toilets [ ]
3. Water Tap [ ]
4. Cable Connection [ ]
5. Electricity [ ]
6. Attached Bathroom [ ]
7. Water Harvesting [ ]

2
C. Assessment Details :

i) Extent of Site (in Sq.mts):

ii) Floor-wise Details:

Floor Classification Nature of Usage In case of Firm Name Occupancy Occupant Construc
No. of the Building (Residential/Non NR, detailed (Owner/ Name tion date
(*) -Residential) usage Tenant)
(**)

Effectiv Length Width Plinth Area Building Building Plan Plinth Area in
e from (in Meter) (in Meter) (in Sq.Mt.) Plan Permission Building Plan
Date Permission date
No.

D. Documents:
i. Document Type 1. Patta Certificate (issued by Revenue Dept.) [ ]
2. Registered will deed [ ]
3. Un-registered will deed [ ]
4. Decre by Civil Court [ ]
5. Un-registered Documents / Notary Document [ ]
6. Registered Document [ ]
ii.Certificate No. & Date
(required only for patta
certificate)
iii.MRO Proceedings No. & Date
(required only for patta
certificate)
iv. Deed No. & Date
(required for Registered/Un-
registered will deed)
v. Testator and Witnesses Signed
(required if Un-registered will
deed)
vi. Decre No. & Date
(required for decre by civil court)
vii. Name of Court
(required for decre bv civil court)
viii. Document No. & Date
(required for Registered
Document)

3
E. Enclosures:
1. Photo of Property / Land [ ]
2. Building Permission copy [ ]
3. Attested copies of Property Documents
i. Patta Certificate [ ]
ii. MRO Proceedings [ ]
iii. Will Deed [ ]
iv. Decree Document [ ]
v. Registered Document [ ]
4. Two Non-Judicial Stamp papers of Rs.10 each [ ]
5. Copy of Death Certificate / Succession [ ]
Certificate / Legal Hair Certificate
6. Any other document [ ]

Applicant Undertaking:
I hereby declare that all the information mentioned above is true to my knowledge. In case of any
discrepancies if arises I will be held responsible. Hence it is requested to assess my property.

Applicant

Office Use Only

I have verified the application and the enclosures and the application qualifies for further verification.

PuraSeva Centre Operator

Note:-
1. Classification of Building: (*)
RCC posh, RCC Ordinary, Madras Terrace, Mangalore Tiles, Country Tiles, AC or Zinc
Sheet

2. Non-Residential detailed usage (**)

Shop, Shopping complex, Office, Bank, ATM, Hospital, Clinic, Dispensary, Lab,
Educational Institute, Hostel, Gym, Star Hotel, Bar/Pub/Restaurant, Hotel, Guest House,
Gowdown, Petrol Bunk, Industry, Cinema Theatre, Multi/group theatres, Function Hall,
Any other usage (specify the usage)

4
 FORM – 002
______________________ MUNICIPALITY /
CORPORATION

APPLICATION FOR ASSESSMENT / RE-ASSESSMENT OF VACANT LAND

TAX

File No
(to be generated by CSC)

A. Owner Details:
Aadhar No. Mobile No. Owner Name Gender Email Guardian Name
Address (S/o, D/o, W/o)

B. Property Particulars:

1.Category of Private [ ] State Govt. [ ] Central Govt. [ ]

Ownership
2.Apartment / Complex
Name
3. Door No. (In case of
existing building)
4. Assessment No. (In
case of existing building)
5.Locality
6.Revenue Zone No.
7.Revenue Ward No.
8.Revenue Block No.
9.Street No.
10.Election Ward No.
11.Property Address

12.Pin Code

C. Vacant Land Details :

1.Survey No.
2.Patta No.
3.Vacant Land Area (in Sq.Mtr.)
4.Market Value (per Sq.Mtr.)
5.Document Value
6.Effective date
7.Surrounding Boundaries:
North –
East –
West –
South -

5
D. Documents:
i. Document Type 1. Patta Certificate (issued by Revenue Dept.) [ ]
2. Registered will deed [ ]
3. Un-registered will deed [ ]
4. Decre by Civil Court [ ]
5. Un-registered Documents / Notary Document [ ]
6. Registered Document [ ]
ii.Certificate No. & Date
(required only for patta certificate)
iii.MRO Proceedings No. & Date
(required only for patta certificate)
iv. Deed No. & Date
(required for Registered/Un-
registered will deed)
v. Testator and Witnesses Signed
(required if Un-registered will deed)
vi. Decre No. & Date
(required for decre by civil court)
vii. Name of Court
(required for decre bv civil court)
viii. Document No. & Date
(required for Registered
Document)

E. Enclosures:
1. Photo of Property / Land [ ]
2. Attested copies of Property Documents
i. Patta Certificate [ ]
ii. MRO Proceedings [ ]
iii. Will Deed [ ]
iv. Decree Document [ ]
v. Registered Document [ ]
3. Two Non-Judicial Stamp papers of Rs.10 each [ ]
4. Copy of Death Certificate / Succession [ ]
Certificate / Legal Hair Certificate
5. Any other document [ ]

Applicant Undertaking:
I hereby declare that all the information mentioned above is true to my knowledge. In case of any
discrepancies if arises I will be held responsible. Hence it is requested to assess my property.

Applicant

Office Use Only

I have verified the application and the enclosures and the application qualifies for further
verification.

PuraSeva Centre Operator

6
 FORM – 003
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR SUBMISSION OF REVISION/GENERAL REVISION

PETITION AGAINST ASSESSMENT / RE-ASSESSMENT OF PROPERTY TAX

File No
(to be generated by CSC)

A. Applicant Particulars:

1. Name of the Applicant

2. S/o, D/o, W/o.

3. Address for correspondence

4. Contact (Mobile) No.

B. Details of property of which the tax is to be revised :

1. Door No.

2. Assessment No.

3. Category of
Ownership
4. Property Type
5.Apartment / Complex
Name
6.Amenities : 1. Lift [ ]
2. Toilets [ ]
3. Water Tap [ ]
4. Cable Connection [ ]
5. Electricity [ ]
6. Attached Bathroom [ ]
7. Water Harvesting [ ]

C. Assessment Details :

i) Extent of Site (in Sq.mts):

ii) Floor-wise Details:

Floor Classification Nature of Usage In case of Firm Occupancy Occupan Construc
No. of the Building (Residential/Non NR, detailed Name (Owner/ t Name tion date
(*) -Residential) usage Tenant)
(**)

7
 Effectiv Length Width Plinth Area Building Building Plan Plinth Area in
e from (in Meter) (in Meter) (in Sq.Mt.) Plan Permission Building Plan
Date Permission date
No.

D. Documents:
i. Document Type 1. Patta Certificate (issued by Revenue Dept.) [ ]
2. Registered will deed [ ]
3. Un-registered will deed [ ]
4. Decre by Civil Court [ ]
5. Un-registered Documents / Notary Document [ ]
6. Registered Document [ ]
ii.Certificate No. & Date
(required only for patta
certificate)
iii.MRO Proceedings No. & Date
(required only for patta
certificate)
iv. Deed No. & Date
(required for Registered/Un-
registered will deed)
v. Testator and Witnesses Signed
(required if Un-registered will
deed)
vi. Decre No. & Date
(required for decre by civil court)
vii. Name of Court
(required for decre bv civil court)
viii. Document No. & Date
(required for Registered
Document)

E. Enclosures:
1. Photo of Property / Land [ ]
2. Building Permission copy [ ]
3. Attested copies of Property Documents
i. Patta Certificate [ ]
ii. MRO Proceedings [ ]
iii. Will Deed [ ]
iv. Decree Document [ ]
v. Registered Document [ ]
4. Two Non-Judicial Stamp papers of Rs.10 each [ ]
5. Copy of Death Certificate / Succession [ ]
Certificate / Legal Hair Certificate
6. Any other document [ ]

8
 Applicant Undertaking
I hereby declare that all the information mentioned above is true to my knowledge. In
case of any discrepancies I will be held responsible.

Signature of the Applicant

Office Use only

I have verified the application and the enclosures and the application qualifies for
further verification.

PuraSeva Centre Operator

Note:-
1. Classification of Building: (*)
RCC posh, RCC Ordinary, Madras Terrace, Mangalore Tiles, Country Tiles, AC or
Zinc Sheet

2. Non-Residential detailed usage (**)

Shop, Shopping complex, Office, Bank, ATM, Hospital, Clinic, Dispensary, Lab,
Educational Institute, Hostel, Gym, Star Hotel, Bar/Pub/Restaurant, Hotel,
Guest House, Gowdown, Petrol Bunk, Industry, Cinema Theatre, Multi/group
theatres, Function Hall, Any other usage (specify the usage)

9
 FORM – 004
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR SUBMISSION OF REVISION/GENERAL REVISION

PETITION AGAINST ASSESSMENT / RE-ASSESSMENT OF VACANT LAND TAX

File No
(to be generated by CSC)

A. Applicant Particulars:

1. Name of the Applicant

2. S/o, D/o, W/o.

3. Address for correspondence

4. Contact (Mobile) No.

B. Details of property of which the tax is to be revised :

1. Door No.

2.Assessment No.

3.Category of
Ownership
4.Property Type
5. Extent of Site (in Sq.
mts)

C. Vacant Land Details :

1.Survey No.
2.Patta No.
3.Vacant Land Area (in Sq.Mtr.)
4.Market Value (per Sq.Mtr.)
5.Document Value
6.Effective date
7.Surrounding Boundaries:
North –
East –
West –
South -

10
D. Documents:
i. Document Type 1. Patta Certificate (issued by Revenue Dept.) [ ]
2. Registered will deed [ ]
3. Un-registered will deed [ ]
4. Decre by Civil Court [ ]
5. Un-registered Documents / Notary Document [ ]
6. Registered Document [ ]
ii.Certificate No. & Date
(required only for patta
certificate)
iii.MRO Proceedings No. & Date
(required only for patta
certificate)
iv. Deed No. & Date
(required for Registered/Un-
registered will deed)
v. Testator and Witnesses Signed
(required if Un-registered will
deed)
vi. Decre No. & Date
(required for decre by civil court)
vii. Name of Court
(required for decre bv civil court)
viii. Document No. & Date
(required for Registered
Document)

E. Enclosures:
1. Photo of Property / Land [ ]
2. Attested copies of Property Documents
i. Patta Certificate [ ]
ii. MRO Proceedings [ ]
iii. Will Deed [ ]
iv. Decree Document [ ]
v. Registered Document [ ]
3. Two Non-Judicial Stamp papers of Rs.10 each [ ]
4. Copy of Death Certificate / Succession [ ]
Certificate / Legal Hair Certificate
5. Any other document [ ]

11
 Applicant Undertaking
I hereby declare that all the information mentioned above is true to my knowledge. In
case of any discrepancies I will be held responsible.

Signature of the Applicant

Office Use only

I have verified the application and the enclosures and the application qualifies for
further verification.

PuraSeva Centre Operator

12
 FORM – 005
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR OBTAINING MUTATION / TRANSFER OF PROPERTY

(Full Transfer - Registration not done)

File No
(to be generated by CSC)

A. Applicant Particulars:
1.Name of the Applicant

2.S/o, D/o, W/o.

3.Postal Address of the Applicant

4.Contact (Mobile) No.

5.Transferer Name

6.Door No.

7.Assessment No.

B. Transferee Details:
Aadhar No. Mobile No. Owner Name Gender Email Guardian Name
Address (S/o, D/o, W/o)

C. Registration Details:

1. Registration document No. & Date

2. Parties consideration value

(Document value)

3. Department guidelines value (Market

Value)

D. Enclosures:
1. Address proof of parties [ ]
2. Affidavit from seller and buyer [ ]
3. Registered title deed [ ]
7. Any other document [ ]

13
Applicant Undertaking :
I hereby declare that all the information mentioned above is true to my knowledge. In case of
any discrepancies I will be held responsible. Hence, I request you to Transfer the property in my
name basing on the documentary evidences.

Date : Applicant’s Signature

Office Use Only

I have verified the application and the enclosures and the application qualifies for
further verification.

PuraSeva Centre Operator. .

14
 FORM – 006
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR OBTAINING MUTATION / TRANSFER OF PROPERTY

(Registration already done)

File No
(to be generated by CSC)

A. Applicant Particulars:
1.Name of the Applicant

2.S/o, D/o, W/o.

3.Postal Address of the Applicant

4.Contact (Mobile) No.

5.Transferer Name

6.Door No.

7.Assessment No.

B. Transferee Details:
Aadhar No. Mobile No. Owner Name Gender Email Guardian Name
Address (S/o, D/o, W/o)

C. Registration Details:

1. Registration document No. & Date

2. Parties consideration value

(Document value)

3. Department guidelines value (Market

Value)

D. Enclosures:
1. Address proof of parties [ ]
2. Affidavit from seller and buyer [ ]
3. Registered title deed [ ]
7. Any other document [ ]

15
Applicant Undertaking :
I hereby declare that all the information mentioned above is true to my knowledge. In case of
any discrepancies I will be held responsible. Hence, I request you to Transfer the property in my
name basing on the documentary evidences.

Date : Applicant’s Signature

Office Use Only

I have verified the application and the enclosures and the application qualifies for
further verification.

PuraSeva Centre Operator .

16
 FORM – 007
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR TAX EXEMPTION

File No
(to be generated by CSC)

A. Applicant Particulars:

1.Name of the Applicant

2.S/o, D/o, W/o.

3.Postal Address of the Applicant

4.Contact (Mobile) No.

5.Door No.

6.Assessment No.

B.Tax Exemption particulars:

Reason for Tax exemption:

i. Places set apart for public worship [ ]

ii. Choultries [ ]
iii. Recognized Educational Institutions / Charitable Institutions.[ ]
iv. Ex-Service men / In-service men of Army [ ]
v. Retired Pensioners Association [ ]
vi. NGO Homes / Teachers Association Buildings [ ]
C. Enclosures:
1. In case of recognized Educational Institutions:
i. Copy of Educational Institute recognition order
ii. Copy of State Gazette/District Gazette, in which the Trust (or) Organization is
notified as Charitable Institution by the Commissioner of Endowments.
iii. Copy of registered Trust Deed under Registration Act, 1908.
iv. Copies of Minutes of the meeting of the Trust/Organization for the last 3 years
v. Copies of Annual Reports/ Audit Reports /Annual Accounts of the organizations,
for the last (3) years

17
 2. In case of charitable institutions:-
i.
ii.
iii.
iv.
v.
3. In case of Ex-Service Man/In-Service man:
i. Proof of identify
ii. Photo of the Applicant

4. In case of Retired Pensioners Association:

i. Copy of Association recognition order of the Government
ii. Copy of resolution for making a request for exemption of property tax
which is
passed in the Association

5. In case of NGO Homes/Teachers Association Buildings

i. Copy oof Association recognition order of the Government
ii. Copy of resolution for making a request for exemption of property tax
which is
passed in the Association

Applicant Undertaking

I hereby declare that all the information mentioned above is true to my

knowledge. In case of any discrepancies I will be held responsible

Signature of the Applicant

Office Use only

I have verified the application and the enclosures and the application qualifies for
further verification.

PuraSeva Centre Operator.

18
 FORM – 008
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR SUB-DIVISION (OR) BIRFURCATION OF PROPERTY

File No
(to be generated by CSC)

A. Applicant Particulars:
1.Name of the Applicant

2.S/o, D/o, W/o.

3.Postal Address of the Applicant

4.Contact (Mobile) No.

5.Door No.

6.Assessment No.

7.Property to be divided into No. of parts

B. Assessment Details :

i) Extent of Site (in Sq.Mts.) to be divided :

Sl.No. Site divided into parts

No. Extent of site

ii) Floor-wise Details and part-wise to be divided:

Floor Classification Nature of Usage In case of Firm Name Occupancy Occupant Construc
No. of the Building (Residential/Non NR, detailed (Owner/ Name tion date
(*) -Residential) usage Tenant)
(**)

Effectiv Length Width Plinth Area Building Building Plan Plinth Area in
19
 e from (in Meter) (in Meter) (in Sq.Mt.) Plan Permission Building Plan
Date Permission date
No.

Applicant Undertaking

I hereby declare that all the information mentioned above is true to my

knowledge. In case of any discrepancies I will be held responsible

Signature of the Applicant

Office Use only

I have verified the application and the enclosures and the application qualifies for
further verification.

PuraSeva Centre Operator

Note:-
1. Classification of Building: (*)
RCC posh, RCC Ordinary, Madras Terrace, Mangalore Tiles, Country Tiles, AC or
Zinc Sheet

2. Non-Residential detailed usage (**)

Shop, Shopping complex, Office, Bank, ATM, Hospital, Clinic, Dispensary, Lab,
Educational Institute, Hostel, Gym, Star Hotel, Bar/Pub/Restaurant, Hotel, Guest
House, Gowdown, Petrol Bunk, Industry, Cinema Theatre, Multi/group theatres,
Function Hall, Any other usage (specify the usage)

20
 FORM – 009
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR VACANCY REMISSION

File No
(to be generated by CSC)

A. Applicant Particulars:

1.Name of the Applicant

2.S/o, D/o, W/o.

3.Postal Address of the Applicant

4.Contact (Mobile) No.

5.Door No.

6.Assessment No.

B. Vacancy Remission Details:

1. Vacancy remission from date

2. Vacancy remission to date

3. Name of the Owner

C. Enclosures:-

1. Photo showing the vacant premises

2. Electricity Bills for the period for which the claim is made

21
 Applicant Undertaking

I hereby declare that all the information mentioned above is true to my

knowledge. In case of any discrepancies I will be held responsible.

Signature of the Applicant

Office Use only

I have verified the application and the enclosures and the application qualifies for
further verification.

PuraSeva Centre Operator

22
 FORM – 010
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR AMALGAMATION OF PROPERTY

File No
(to be generated by CSC)

A. Applicant Particulars:

1.Name of the Applicant

2.S/o, D/o, W/o.

3.Postal Address of the Applicant

4.Contact (Mobile) No.

5.Door No.

6.Assessment No.

B. Amalgamated Properties Detail :

Assessment No. Owners Name

C. Owners to be added:
Aadhar No. Mobile No. Owner Name Gender Email Guardian Name
Address (S/o, D/o, W/o)

D. Property Particulars:

1.Category of
Ownership
2.Property Type
3.Apartment / Complex
Name
4.Locality
5.Revenue Zone No.

23
 6.Revenue Ward No.
7.Revenue Block No.
8.Street No.
9.Election Ward No.
10.Property Address

11.Pin Code
12.Amenities : 1. Lift [ ]
2. Toilets [ ]
3. Water Tap [ ]
4. Cable Connection [ ]
5. Electricity [ ]
6. Attached Bathroom [ ]
7. Water Harvesting [ ]

E. Assessment Details (After amalgamation) :

i) Extent of Site (in Sq.mts):

ii) Floor-wise Details:

Floor Classification Nature of Usage In case of Firm Name Occupancy Occupant Construc
No. of the Building (Residential/Non NR, detailed (Owner/ Name tion date
(*) -Residential) usage Tenant)
(**)

Effectiv Length Width Plinth Area Building Building Plan Plinth Area in
e from (in Meter) (in Meter) (in Sq.Mt.) Plan Permission Building Plan
Date Permission date
No.

24
 Applicant Undertaking

I hereby declare that all the information mentioned above is true to my

knowledge. In case of any discrepancies I will be held responsible

Signature of the Applicant

Office Use only

I have verified the application and the enclosures and the application qualifies for
further verification.

PuraSeva Centre Operator

Note:-
1. Classification of Building: (*)
RCC posh, RCC Ordinary, Madras Terrace, Mangalore Tiles, Country Tiles, AC or
Zinc Sheet

2. Non-Residential detailed usage (**)

Shop, Shopping complex, Office, Bank, ATM, Hospital, Clinic, Dispensary, Lab,
Educational Institute, Hostel, Gym, Star Hotel, Bar/Pub/Restaurant, Hotel, Guest
House, Gowdown, Petrol Bunk, Industry, Cinema Theatre, Multi/group theatres,
Function Hall, Any other usage (specify the usage)

25
 FORM – 011
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR DEMOLITION OF PROPERTY

File No
(to be generated by CSC)

A. Applicant Particulars:

1.Name of the Applicant

2.S/o, D/o, W/o.

3.Postal Address of the Applicant

4.Contact (Mobile) No.

5.Door No.

6.Assessment No.

7.Date of demolition

B. Vacant Land Details :

1.Survey No.
2.Patta No. (If it is a patta)
3.Vacant Land Area (in Sq.Mtr.)
4.Market Value (per Sq.Mtr.)
5.Document Value
6.Effective date
7.Surrounding Boundaries:
North –
East –
West –
South -

Applicant Undertaking

I hereby declare that all the information mentioned above is true to my

knowledge. In case of any discrepancies I will be held responsible

Signature of the Applicant

26
 Office Use only

I have verified the application and the enclosures and the application qualifies for
further verification.

PuraSeva Centre Operator

27
 FORM – 012
______________________ MUNICIPALITY / CORPORATION
APPLICATION FOR OWNERSHIP CERTIFICATE

File No
(to be generated by CSC)
Applicant Particulars:
1.Name of the Applicant
2.S/o, D/o, W/o.
3.Postal Address of the Applicant

4.Contact (Mobile) No.

5.Door No.
6.Assessment No. for which
Ownership Certificate is required

Applicant Undertaking

I hereby declare that all the information mentioned above is true to my

knowledge. In case of any discrepancies I will be held responsible.

Signature of the Applicant

Office Use only

I have verified the application and the enclosures and the application qualifies
for further verification.

PuraSeva Centre Operator

28
 FORM – 013
______________________ MUNICIPALITY / CORPORATION
APPLICATION FOR VALUATION CERTIFICATE

File No
(to be generated by CSC)
A. Applicant Particulars:
1.Name of the Applicant
2.S/o, D/o, W/o.
3.Postal Address of the Applicant

4.Contact (Mobile) No.

5.Door No.
6.Assessment No. for which
Valuation Certificate is required

B. ENCLOSURES: -
1. Photo of the Owner
2. Building front elevation photo.

Applicant Undertaking

I hereby declare that all the information mentioned above is true to my

knowledge. In case of any discrepancies I will be held responsible.

Signature of the Applicant

Office Use only

I have verified the application and the enclosures and the application qualifies
for further verification.

PuraSeva Centre Operator

29
 FORM – 014
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR NEW / ADDITIONAL WATER TAP CONNECTION

File No
(to be generated by CSC)

A. Applicant Particulars:

1.Name of the Applicant

2.S/o, D/o, W/o.

3.Postal Address of the Applicant

4.Contact (Mobile) No.

5.Door No.

6.Assessment No.

7.Consumer No. (In case of Additional Water

Tap connection)

B. Connection Details :

1. Water Source Type Ground Water [ ] Surface Water [ ]

2. Connection Type Metered [ ] Non Metered [ ]

3. Property Type
Residential [ ] Non Residential [ ]

4. Category BPL [ ] General [ ] OYT [ ] NSDP [ ]

5. Usage Type Domestic [ ] Commercial [ ]
6. Pipe Size 1 inch [ ] ½ inch [ ] 3/2 inch [ ] ¾ inch [ ]
7. Sump capacity (in Lts.)
8. No. of Persons

C. Enclosures:
1. Property Tax receipt [ ]
2. Distribution Line Location Map [ ]
3. White Ration Card (in case of BPL) [ ]
4. 20/- Non Judicial Stamp Paper [ ]
5. Any other document [ ]

30
 Applicant Undertaking:

I hereby declare that all the information mentioned above is true to my knowledge. In case of any
discrepancies if arises I will be held responsible.Hence it is requested to accord sanction for Water Tap
Connection / Additional Water Tap Connection in my house.

Applicant

Office Use Only

I have verified the application and the enclosures and the application qualifies for further verification.

PuraSeva Centre Operator

FORM – 015

31
 ______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR CHANGE IN USAGE OF WATER TAP CONNECTION

File No
(to be generated by CSC)

A. Applicant Particulars:

1.Name of the Applicant

2.S/o, D/o, W/o.

3.Postal Address of the Applicant

4.Contact (Mobile) No.

5.Door No.
6.Assessment No.
7.Consumer No.

B. Connection Details :

1. Connection Type Metered [ ] Non Metered [ ]

2. Usage Type Domestic [ ] Commercial [ ]
3. Category BPL [ ] General [ ] OYT [ ] NSDP [ ]

4. Property Type Residential [ ] Non Residential [ ]

5. Pipe Size 1 inch [ ] ½ inch [ ] 3/2 inch [ ] ¾ inch [ ]
6. Water Source Type Ground Water [ ] Surface Water [ ]
7. Sump capacity (in Lts.)
8. No. of Persons

9. Date from which the

change in usage is
requested
10. Reason for Change of
Use.

C. Enclosures:
1. Documents if any [ ]
Applicant Undertaking:

I hereby declare that all the information mentioned above is true to my knowledge. In case of any
discrepancies if arises I will be held responsible. Hence it is requested to change in usage of my water tap
connection.

Applicant

Office Use Only

I have verified the application and the enclosures and the application qualifies for further verification.

PuraSeva Centre Operator

32
 FORM – 016
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR CLOSURE OF WATER TAP CONNECTION

File No
(to be generated by CSC)

A. Applicant Particulars:

1.Name of the Applicant

2.S/o, D/o, W/o.

3.Postal Address of the Applicant

4.Contact (Mobile) No.

5.Door No.

6.Assessment No.

7.Consumer No.

B. Closure of Connection Details :

1. Connection Closure Type Temporary [ ] Permanent [ ]

2. Reasons for closure

C. Enclosures:

1. Document if any [ ]

Applicant Undertaking:

I hereby declare that all the information mentioned above is true to my knowledge. In case of any
discrepancies if arises I will be held responsible.Hence it is requested to assess disconnect my water tap
connection in view of the reasons mentioned above.

Applicant

Office Use Only

I have verified the application and the enclosures and the application qualifies for further verification.

PuraSeva Centre Operator

33
 FORM – 017
______________________ MUNICIPALITY / CORPORATION APPLICATION

APPLICATION FOR OBTAINING TRADE LICENSE CERTIFICATE

File No
(to be generated by CSC)

A. Applicant Particulars:
1. Name of the Applicant

2. S/o, D/o, W/o.

3. Postal Address of the

Business Owner
4. Address of the business
establishment

5. Contact (Mobile) No.

6. Property Tax Assessment
No. of Business
establishment

B. Trade Details :

1. Nature of Trade

2. Title of Trade

3. Brief Description of trade

4. Type of Business
establishment
[]Own []Rented

(Incase of rented, Rental Agreement should be enclosed)

5. If Rent, Monthly Rent of
Business establishment
6. Trade Existing Zone [] Residential [] E Commercial
7. Plinth Area of the
establishment
8. No. of workers
9. H.P. Required
10.No. of machines
11.Period of license required

C. Enclosures:
1. Self Assessment Form [ ]
2. Rental Deed/Lease Deed/Sale Deed [ ]
3. Property tax receipt up-to-date paid [ ]
4. Location plans – Blue Print Copies -3 [ ]
5. NOC from two Immediate neighbours [ ]
6. Sanctioned Plan. [ ]
7. Passport Size Photos -2 [ ]

34
 Applicant Undertaking:
I hereby declare that all the information mentioned above is true to my knowledge. In
case of any discrepancies if arises I will be held responsible. Hence I request you to issue
me D & O Trade License.

Date: Applicant’s Signature

Office Use Only

I have verified the application and the enclosures and the application qualifies for further
verification.

PuraSeva Centre Operator

35
 FORM – 018
______________________ MUNICIPALITY / CORPORATION APPLICATION

APPLICATION FOR OBTAINING RENEWAL OF EXISING TRADE LICENSE

CERTIFICATE

File No
(to be generated by CSC)

A. Applicant Particulars:
1. Name of the Applicant

2. S/o, D/o, W/o.

3. Postal Address of the

Business Owner
4. Address of the business
establishment

5. Contact (Mobile) No.

6. Property Tax Assessment
No. of Business
establishment
7. Existing Trade License
Assessment No. (in case
of renewal)

B. Trade Details :

1. Nature of Trade

2. Title of Trade

3. Brief Description of trade

4. Type of Business
establishment
[]Own []Rented

(Incase of rented, Rental Agreement should be enclosed)

5. If Rent, Monthly Rent of
Business establishment
6. Trade Existing Zone [] Residential [] E Commercial
7. Plinth Area of the
establishment
8. No. of workers
9. H.P. Required
10.No. of machines
11.Period of license required

C. Enclosures:
1. Property tax receipt up-to-date paid [ ]

2. Previous year trade license fee paid receipt [ ]

36
 Applicant Undertaking:
I hereby declare that all the information mentioned above is true to my knowledge. In
case of any discrepancies if arises I will be held responsible. Hence I request you to issue
me D & O Trade License.

Date: Applicant’s Signature

Office Use Only

I have verified the application and the enclosures and the application qualifies for further
verification.

PuraSeva Centre Operator

37
 FORM – 019
______________________ MUNICIPALITY / CORPORATION APPLICATION

APPLICATION FOR OBTAINING CHANGE OF NAME IN THE EXISING TRADE

LICENSE CERTIFICATE

File No
(to be generated by CSC)

A. Applicant Particulars:
1. Name of the Applicant

2. S/o, D/o, W/o.

3. Postal Address of the

Business Owner
4. Address of the business
establishment

5. Contact (Mobile) No.

6. Property Tax Assessment
No. of Business
establishment
7. Existing Trade License
Assessment No.

B. Trade Details :

1. Existing Title of the

Trade
2. Title of the Trade to
be changed

C. Enclosures:

1. Documents if any [ ]

Applicant Undertaking:
38
I hereby declare that all the information mentioned above is true to my knowledge. In
case of any discrepancies if arises I will be held responsible. Hence I request you to change the
Title of the Trade.

Date: Applicant’s Signature

Office Use Only

I have verified the application and the enclosures and the application qualifies for further
verification.

PuraSeva Centre Operator

39
 FORM - 020
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR BIRTH CERTIFICATE

(Write in Capital Letters)

1. Date Of Birth
2. Se x
3. Child Name
a. If Registered Mention the Child Name.
b. If Child Name not included a separate form to be filled by the Father and Mother of the
child
4. Name of the Father

5. Name of the Mother

6. Place of Birth

(Tick the appropriate entry a, b, c below and give the name of the Hospital/Institute or the Address of
the House where the Birth took place.lf other place give location)
a) Hospital/Institution Name
b) House Address
c) Other place
7. No.Of Copies Required

8. a) Do you want the Birth Certificate by Courier- Yes/No

b) If Yes give Name and Address with PinCode

(Signature of theName & address,Applicant)

MOBILE No:

Note:- Birth certificate will be issued subject to entry found Registered in

Municipal records.

CSC Transaction No: CSC Transaction Date:

Secretariat No:

40
41
 FORM – 021
______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR INCLUSION OF CHILD NAME IN THE BIRTH CERTIFICATE

REGISTRATION OF CHILD NAME AFTER ONE YEAR OCCURANCE

From To
Name The Registrar of Birth and Deaths,
Address:
Telephone No:
Secretariat No:

Sir,
I _____________________________________________________________________S/o.
/W/o._________~___________

Aged about_________________years working as__________________(Designation

& office Address) Residing at H.No__________________________________(Complete door no.)

Declare that my wife Delivered Male / Female child at__________________________

___________________(Actual place of Birth) on_________________(Date of Birth)

Hence, we Request to include our child name as________________________

(Write in Capital Letters)In the Birth Register of the year___________________

Signature & Signature &

Name of the father of the child Name of the mother of the child
I hereby enclose the following photo copies with attestation for issuance child name inclusion in
certificate
1. Ration Card/ any other Residence Proof
2. School Bonafied Certificate
3. Notarized Affidavit
4. Birth Certificate

42
 FORM – 022

______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR INCLUSION OF CHILD NAME IN THE BIRTH CERTIFICATE

REGISTRATION OF CHILD NAME WITHIN ONE YEAR OCCURANCE

From To

Name The Registrar of Birth and Deaths,

Address:

Mobile No:

Secretariat No:

Sir,

III____________________________________________________________________S/o./W/o._________________
______________

Aged about___________________years working as______________________________

(Designation& office Address) Residing at H.No__________________________________

(Complete door no.)

Declare that my wife Delivered Male / Female child at_____________________________

______________________(Actual place of Birth) on___________________(Date of Birth)

Hence, we Request to include our child name as_____________________________

(Write in Capital Letters)In the Birth Register of the year_______________________

Signature & Signature &

Name of the father of the child Name of the mother of th

43
 FORM – 023

______________________ MUNICIPALITY / CORPORATION

APPLICATION FOR CORRECTIONS OF BIRTH AND DEATH

ENTRIES

I_____________________________S/o________________________________
_Aged about_______years working as
(Designation and complete address of the individual of the firm)
Residing at

__________________________________________________________________________

__________________(Complete Door No. Street and Station has to be stated with

Telephone No).
Declare that

I/My__________________________________Delivered Male child/Female child

Born/Died in____________________________________________________________
(Actual place of event) on_______________________________________(date of event).

The Birth/Death Certificates issued on_________________________________________

The name/s was wrongly informed by________________________________(the person
who informs the event has to be stated)please do the following.

Incorrect Name To be Corrected as

44
 SIGNATURE OF THE DECLARANT
Date: (Declarant’s name in Capital)
Secretariat No: Mobile No:

I know Sri/Smt____________________________________
S/o/W/o______________________
___________________ as a resident of
___________________________________________________
The signature of the declarant is taken in my presence and the contents mentioned by the
Declarant are
True and correct to the best of my knowledge and belief.

1. 2.

GAZETTED OFFICER GAZETTED OFFICER

Sign & Seal & Sign & Seal &
(Name of the Officer) (Name of the Officer)

CSC Transaction No. CSC Transaction Date:

The following documents should be produced by the declarant for name corrections in
Birth/Death
registers:

1. Declaration by the nearest relative (Parents/Childres`s/Spouse) in case of death and either

father
or mother in case of liver Birth
2. The declaration stated should be true and correct by two Gazatted Officers (Names of Gazetted
Officers are to be written in CAPITALS).
3. Notary Affidavit on (Rs.10/- Non Judicial Stamped Paper).
4. The Original Birth / Death Certificates already taken are to be returned
5. Documentary Evidences like Educational Certificates, Election ID Card, Ration Card, Passport,
Driving Licenses, Marriage Certificate, LIC Policies, Caste Certificates, Property Papers, etc.,
(Evidence to be submitted before Birth of the Child or Death of the Deceased)
6. Consent Letter from the concerned Hospital regarding the correction to the effect
7. Other Child Certificates if any
8. In case of Medico Legal Death a) FIR b) Post Mortem Report c)Form_2 by concerned Police
Station
9. Any other support documents if any please specify.

45
 FORM – 024

_____________________ MUNICIPALITY / CORPORATION

APPLICATION FOR NON AVAILABILITY CERTIFICATE FOR BIRTH

From To
Name: The Registrar Birth and Death,
Address:
Telephone No:
Sir,
Sub: - Request of Non-availability Certificate —Reg.
Ref: - Your Endorsement Dated No.
***

I,____________________________________S/o./W/o._______________________________
Aged about_________________years working as___________________(Designation & office
Address) Residing at H.No_____________________________________________________
(Complete door no.)

__I declare that My wife Delivered Male/Female child in

(Place of Birth) on___________________(Date of Birth)

I hereby enclose the following photo copies with attestation for issuance of Non-Availability
certificate.

1.Ration Card/Any other Residence Proof

2.School Bonofied Certificate
3.Secondary School Marks Sheet.
4.Notarized Affidavit
5.Any other supporting documents if any please specify

Signature of the Applicant

46
 FORM – 025

_____________________ MUNICIPALITY / CORPORATION

APPLICATION FOR DEATH CERTIFICATE

(Write in Capital Letters)

1. Date Of Death
2. Name of the Deceased
3. Sex of the Deceased
4. Name of the Father of the deceased:
5. Name of the Mother
6. Place of Death
(Tick the appropriate entry a, b, c below and give the name of the Hospital/Institute or the Address of
the House where the Death took place. If other place give location)

a) Hospital/Institution Name :
b) House Address
c) Other place
7. No. of Copies Required
8. a) Do you want the Death Certificate by Courier- (Yes / No.)
b) If Yes give Name and Address with Pin Code

Name & address. (Signature of the Applicant)

Telephone No:

Note:- Death certificate will be issued subject to entry found Registered in Municipal records.
 FORM – 026

_____________________ MUNICIPALITY / CORPORATION

APPLICATION FOR NON AVAILABILITY CERTIFICATE FOR DEATH

From To
Name: The Registrar of Birth and Deaths,
Address:
Telephone No:

Sir,

Sub: - Request of Non-availability Certificate –Reg.

Ref: - Your Endorsement Dated__________________ No.____________________.

><<>><

I,________________________________S/o./W/o._____________________________

Aged about ________________ years working as __________________ (Designation

& office Address) Residing at H.No ____________________________(Complete door no)

I declare that My_______________died in _______________(Place of Birth)

on____________
(Date of Birth)

I hereby enclose the following photo copies with attestation for issuance of Non-Availability
certificate.
1. Ration Card/Any other Residence Proof
2. Notarized Affidavit
3. Other Documentary Evidences to prove the place of Death
4. Burial Ground Receipt
5. In case of Medico Legal cases
a) FIR (b) PM Report (c) Form_2 given by concerned Police Station
6. Any other supporting documents if any please specify

Signature of the Applicant

 FORM – 027

_____________________ MUNICIPALITY / CORPORATION

APPLICATION FOR OBTAINING SANITATION CERTIFICATE

A. Applicant Particulars

1. Circle No.
2. Name of the applicant
3. Father's Name / Husband Name
4. Postal Address of the Applicant
5. Address of the premises seeking
sanitation certificate
6. Contact (Mobile) No.
8. Property Tax Assessment No. of
Business establishment

B.
1. Nature of business establishment
2. The premises is [ ] Own [ ]Rented [ ]Lease

3. Date of occupying the premises

4. Probable number of occupants
5. Number of rooms
6. Water storage capacity
7. Number of urinals
8. Number of Toilets
Applicant Undertaking:

I hereby declare that all the information mentioned above is true to my knowledge. In case of any
discrepancies if arises I will be held responsible. Hence I request you to issue me Sanitation
certificate.

Date: Applicant's Signature

List of Enclosures
1. Attested copy of property documents (own)
2. Attested copy of lease agreement (in case lease / rent)
3. Property Tax Receipt

Office Use Only

I have verified the application and the enclosures and the application qualifies for further verification.
Thereby it is requested to collect the processing fees of Rs.________________

PuraSeva Centre Operator

 Form – 028
Application for Marriage Registration
[See Section 8 of Andhra Pradesh Compulsory Registration of Marriage Act,
2002]
Memorandum of Marriage
1 Date of Marriage* : ____/_____/________
. [Future Date should not be entered]
2 Place of Marriage*
.
Venue : Residence/ Function Hall/ Worship Place/ Others<drop-
down>
Street : [For Function Hall/Worship Place/Others <textbox for
Locality : entering>]
City Town : _______________________________________________
__
_______________________________________________
__
_______________________________________________
__
3 Bridegroom’s Particulars
.
Full Name* : _______________________________________________
Father’s/Mother’s Name* : __
His Age at the time of : _______________________________________________
Marriage* : __
Usual Place of Residence : _______________________________________________
Street* : __
Locality* : _______________________________________________
City Town* : __
Status of Bridegroom _______________________________________________
at the time of : __
Marriage* : _______________________________________________
Aadhar : __
Mobile No. * : _______________________________________________
eMail : __
 Religion Unmarried / Widowed / Divorced
Educational :
Qualification : _______________________________________________
__
Occupation _______________________________________________
Nationality __
_______________________________________________
__

Illiterate; Literate; SSC; Intermediate; Graduate; Post

Graduate; Doctorate
_______________________________________________
__
_______________________________________________
__
Witness
a. Name* : _______________________________________________
__
S/o. W/o. D/o. * : _______________________________________________
__
Age* : _______________________________________________
__
Usual Place of : _______________________________________________
Residence* __
Relationship* : _______________________________________________
__
Aadhar : _______________________________________________
__
b. Name* : _______________________________________________
__
S/o. W/o. D/o. * : _______________________________________________
__

Age* : _______________________________________________
__
Usual Place of : _______________________________________________
Residence* : __
Relationship* _______________________________________________
 __
Aadhar : _______________________________________________
__
4 Bride’s Particulars
.
Full Name*
Father’s/Mother’s Name* : _______________________________________________
Her Age at the time of : __
Marriage* : _______________________________________________
Usual Place of Residence : __
Street* : _______________________________________________
Locality* : __
City Town* : _______________________________________________
Status of Bride __
at the time of : _______________________________________________
Marriage* : __
Aadhar : _______________________________________________
Mobile No. * : __
eMail : Unmarried / Widowed / Divorced
Religion
Educational : _______________________________________________
Qualification : __
_______________________________________________
Occupation __
Nationality _______________________________________________
__

Illiterate; Literate; SSC; Intermediate; Graduate; Post

Graduate; Doctorate
_______________________________________________
__
_______________________________________________
__
Witness
c. Name* : _______________________________________________
__
S/o. W/o. D/o. * : _______________________________________________
 __
Age* : _______________________________________________
__
Usual Place of : _______________________________________________
Residence* __
Relationship* : _______________________________________________
__
Aadhar : _______________________________________________
__
d. Name* : _______________________________________________
__
S/o. W/o. D/o. * : _______________________________________________
__
Age* : _______________________________________________
__
Usual Place of : _______________________________________________
Residence* : __
Relationship* _______________________________________________
__
Aadhar : _______________________________________________
__

Signature of the Applicant