Application for grant of Petroleum Mining Lease

Section

To,

THE SECRETARY TO THE GOVT. OF ASSAM,MINES AND MINERALS,DISPUR, GUWAHATI-6(THROUGH THE DIRECTOR, DIRECTORATE OF GEOLOGY AND MINING, ASSAM, KAHILIPARA, GUWAHATI-19.)

Sir,

I/We request for re-grant of Petroleum Exploration License / Petroleum Mining lease under the P& NG Rule 1959(Amendment Rule 2003) with respect to Area admeasuring Sq.Km in District Assam.

Applicant Details

Unique Business Identification Number(UBIN) *

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Name of the applicant *

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Address of the Applicant

Street Name1 *

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Street Name 2

Village/Town

Country *

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State *

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District

Pincode *

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Mobile Number

E-Mail

Other Details

Is the applicant a private individual/private ?

If the applicant is a statutory corporation?

If so give details :

Name of the Act

Act No. under which it is constituted

Profession of the applicant

Nature of business of the applicant

Item or Items the applicant intends to

Period for which the license/mining lease is required

Extent of the area the applicant wants to mine

Details of the area for which mining lease is required :

(a) Name of the area

(b) Name of the District

(d) Area in square kilometers

Is the area applied for ML and as :- described above or part thereof comes under any mining granted to the applicant earlier. If yes, :

(a) The date of grant of the ML

(b) Area of the lease

(d) Cumulative Production of Oil and Natural gas during the lease hold Period

A brief description of the area with particular reference to natural or other surface features such as river stream, roads, township etc.

Whether or the proposed area for ML or part thereof falls within any reserve forest. If so, mention the area in sq.km that falls within R.F along with the name of R.F.

Section

The area applied for Mining lease should be marked on the plan as detailed below. :

a) The area should be marked on a plan drawn to the scale showing on this plan important surface & natural features, District, Mining lease & PEL boundaries if any, the dimensions of the lines forming the boundary of the area & the bearing and the distance of all corner points from any important /prominent and fixed point or points

b) If the area or part thereof falls within any reserve forest , this should be shown properly demarcated in the plan indicating the area in Sq.km. under R.F. Here mention the name & address of the Forest Division / Divisions under whose jurisdiction the area falls

Sl. No.

Name

Address

Sl. No.

Name

Address

c) The map of the proposed ML the concerned revenue authority under proper seal & signature Here mention the name , designation& address of the concerned revenue authorities by whom the relevant map has been authenticated

Sl. No.

Name

Designation

Address

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Name

Designation

Address

Section

The probable date, month with effect from which the applicant intends to start mining operation in the area

The targeted production of enclosed as Annexure-II Oil & Gas production figures enclosed. Crude oil in the 1 st five years of the lease

Any other particulars

Fee Details

Challan Amount *

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Challan No *

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Bank Name *

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Challan Date *

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