Create Form IX

Finacial Year*

Nature of Permit*

Licence No.*

Licence Date*

Individual Firm / Company

Applicant Name*

Age*

Relation Name*

Mobile No.*

DoorNo/Street*

Locality*

City/State*

Region*

Commune*

Village*

Name of the Company*

Name of the owner*

Mobile No.*

Landline No.

DoorNo/Street*

Locality*

City/State*

Region*

Commune*

Village*

Purpose*

Sinking of well Transport of groundwater

Purpose*

By Whom Transported*

From Where Transported*

Mode of Transport*

Registration No. Vehicle*

Water transported per day*

No.of trips per day*

Whether consent of the owner is obtained*

Yes No

Details of machinary and equipments	Make	Year of purchase	Regn. No.	Total Nos.
(i) Drilling Rig
(ii) Engine Set
(ii) Hand boreset
(iii) Air-Compressor
(iv) Electrical logger
(v) Lorry
(vi) Tractor
(vii) Others