INFORMATION COMMUNICATION AND TECHNOLOGY CENTER

KARNATAKA FOREST DEPARTMENT

BANGALORE

CLAIM VERIFICATION FORM

1 Claimants Code (if any) :

2 Track Name in GPX file :
3 Claimants Name :
4 Claimants Gender :
5 Claimant Type :
6 Claim Type :
Since How Many Years :
7 Details of Land Measured :
7.1 Date of Measurement :
7.2 Datum : WGS 84
7.3 Unit : Degree Decimal
7.4 Projection : Polyconic
7.5 Name of Forest :
7.6 Village :
7.7 Taluk :
7.8 District :
7.9 Area :
7.10 A Unit used by GPS Machine : Square Meters
7.11 Shape of the land measured (Polygon) :

Deputy Conservator of Forests. Surveyor

(Signature with date) (Signature with date)