GOVERNMENT OF GOA

DIRECTORATE OF SETTLEMENT & LAND RECORDS,

PANAJI - GOA.

OFFICE OF THE INSPECTOR OF SURVEY & LAND RECORDS

CITY SURVEY _______________________

APPLICATION - FORM
FOR
CERTIFIED COPY OF SURVEY PLAN/FORM 'B'

1) Name of the Applicant :

2) Residential Address
: I) House No. : ________________________
ii) Ward : ________________________
iii) Village : ________________________
iv) District : ________________________
v) Taluka : ________________________

Details of Property

3) Village : ______________________________
4) Taluka : ______________________________
5) Survey No./Sub-Div.No : ______________________________

Signature of the Applicant

Date :
Place :

For Office use