Application for purchase of site - KUDHT

APPLICATION FOR PURCHASE OF SITE

Name of the Applicant (in Block Letters)

Date Of Birth

Age

Father’s / Husband’s Name

Whether the applicant belongs SC/STYesNoIf “Yes” Certificate Issued by competent authority should be submitted later

Address for Correspondence

City

State

ZIP / Postal Code

Country

Phone/Mobile

Email Address

Employment Address

City

State

ZIP / Postal Code

Country

Whether the applicant is and Ordinary resident or Native of KarnatakaOrdinary residentNative of Karnataka

Nominee Name

Nominee Age

Nominee Address

City

State

ZIP / Postal Code

Country

Nominee Relationship

Details / Particulars of my family member Staying with me: