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Form No. General 134
(A 4* S.,T. & E.) 07/75
(Internet Version)

¢¶Š ¡ºà¨Ç / Âó ªæ¾ùÄ´ ¡ÉÌÇ ¢ÈàÈéïŠ ¡ÆóŠÀº

¯ÇµÈ ̯ǿÆÁζ /жƶί¯ÆÐ¹Æ Ì¹ÞÁζ £Ùº¶È¹Æ¹¶½Æ¯Ç¸ Œ®µ¹Æ¹ºÆ
APPLICATION FOR SANCTION TO ACQUIRE / LEASE LAND
(¡åƺ¾ ÌâªòÍïÆà XXXIII ɾ ÀփïؼïÆà 3 ɾ ï¨å´Ì ÂȾà¾)
(¶Ç¹¸¯Æ ͯÇÎÁŠ XXXIII¤ºÆ £¶Æ¶È»Ç»¶Æ¶È 3 ¤ºÆ ‰¼ÈÎÁ¹Æ ¹Ç¼Æ¯Æ¯)
(Vide Sec. 3 Chapter XXXIII of Establishments Code)

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Government Agent District

1. ¡ÆóŠ¨Çæïªà ¾Ä º¾ºëÇ
Œ®µ¹Æ¹¯Æ¯Ç¼¼È ̹»¼Æ ¹¶Œ¹Æ ̹»¼Æ
Name of Applicant Designation

2. Çå°¨åÖ ÈèÀè¾Æ ïÀð¼àªÈè¨ ÈèÀè¾Æ

£ßÁ¾¯ Û¯Á¼È ̱Ƿƶ Û¯Á¼È
Official Address Private Address

3. ¢¶ïŠ ¾Ä ÀèÍú›Ä/ £Îº·Æ׿ƿ ¥´ºÆ/ Situation-

¯ÇµÈŠ ̹»¼Æ Àòå.¡å.¾ø ï¨å´Ì
Name of Land ¹°£°§ ¹Ð¶È
4. ¢¶ïŠ ÌàÉÃåÉÆ D.R.O’s Division
¯ÇµÈŠ ¶Îº ªòåÄïÌàɨ ï¨å´Ì
Nature of Land ¯È¼ÇºÍ±ÎÁ»Ç¿¼Æ ¹Ð¶È
Grama Sevaka Division
5. ¢¶ïŠ ÀòÄå¸Æ ¡. ª° A. Çç. Þ{° R. À. ͹° P. Çæ. ô° Rs.
¯ÇµÈŠ ¹¼¹Æ¹¿â
Extent of Land
¢¶ïŠ ɐ¾å¨Ä
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Value of Land

6. Àò¼å¾Æ ¨Ç¾/—¨ë¸¾ ¡Æïªà ¾Ä Èè À è ¾ Æ

Œ½Æ¹Á¼È/·Ì¯Çδ Û¯Á¼È
»¿È¹Æ¹Á¼È¸Æ ̹»¼Æ Address
Name of vendor/donor

¼ú¾Æ/ Ͷ¶È/ Date

7. ¡ºà¨Ç /Âó ªæ¾ùïŠ ÌàÉÃåÉÆ
̯ǿÆÁ¸Œ/жƶί»È É. ¤° Y. Äå. ºÇ° M. ¼ú. ·Ç° D.
¶Îº
Nature of acquisition/lease

8. ¡ºà¨Ç/Âó ªæ¾ùÄ´ ïÍàºë

̯ǿÆÁ¸â¯ÆмȻ/жƶί¯ÆйÆ
̹ÞÁ¶½ÆмȻ ¯Ç¼µ+Ư¿Æ
Reasons for acquisition/lease

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¡ÆóŠ¨Çæïªà ¡ºà̾
Œ®µ¹Æ¹¯Æ¯Ç¼¼È ί̻ǹƹºÆ
¼ú¾Æ/Ͷ¶È/Date Signature of Applicant

[¡¾ø¨à Àè´ ÂȾà¾./ º°¹° ¹Ç° / P.T.O.

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Government Agent No.

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To be used by Govt. Agent, if necessary

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Secretary No.

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