Government of Tripura
Office of the DM and Collector
Application for Setting Up A Retail Outlet For Storage, Sale And Transportation of Petroleum, Diesel Etc.-EoDB

Applicant’s Personal Details

Name of the Retail Outlet *

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Retail Outlet Setting Up *

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Name of the Applicant *

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Designation *

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Name of the PSU *

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E-Mail *

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Mobile Number *

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State *

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District Name *

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Pin Code *

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Service Specific Information-Place of Business

District *

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Sub-division *

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Location Type *

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Block *

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Gram Panchayat *

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Habitation *

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Municipal Council *

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Ward *

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Village/Area Name *

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Municipal Corporation *

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Ward *

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Village/Area Name *

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Nagar Panchayat *

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Ward *

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Village/Area Name *

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ADC Block *

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Village Council *

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Habitation *

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Police Station *

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Quick Post Office Search

Post office & Pin *

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Service Specific Information-Business Description

Product Type *

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Business Type *

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Particular and Land Details

Revenue Circle *

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Tehsil *

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Mouja/Revenue Village *

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No of Khatian Details to be Eneterd *

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Registered Deed No. *

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Nature of the Deed *

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Duration of Lease/Agreement (In Months) *

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Khatian-1

Khatian No. *

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Owner and Plot Details for Khatian-1

Owner Details

Owner Name *

Owner Share *

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Plot Details

Plot No. *

Total Area *

Classification

North Boundaries

Is Plot Required? *

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Classification

North Boundaries

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Yes

No

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Khatian-2

Khatian No. *

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Owner and Plot Details for Khatian -2

Owner Details

Owner Name *

Owner Share *

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---pendingNotExist--- Owner Share * ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Plot Details

Plon No. *

Total Area *

Classification

North Boundaries

Is Plot Required? *

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---pendingNotExist--- Total Area * ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Classification

North Boundaries

---pendingNotExist--- Is Plot Required? *

Yes

No

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Khatian-3

Khatian No. *

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Owner and Plot Details for Khatian -3

Owner Details *

Owner Name *

Owner Share *

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---pendingNotExist--- Owner Share * ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Plot Details *

Plot No. *

Total Area *

Classification

North Boundaries

Is Plot Required? *

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---pendingNotExist--- Total Area * ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Classification

North Boundaries

---pendingNotExist--- Is Plot Required? *

Yes

No

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Khatian-4

Khatian No. *

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Owner and Plot Details for Khatian -4

Owner Details

Owner Name *

Owner share *

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---pendingNotExist--- Owner share * ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Plot Details

Plot No. *

Total Area *

Classification

North Boundaries

Is Plot Required? *

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---pendingNotExist--- Total Area * ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Classification

North Boundaries

---pendingNotExist--- Is Plot Required? *

Yes

No

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Khatian-5

Khatian No. *

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Owner and Plot Details for Khatian -5

Owner Details

Owner Name *

Owner Share *

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---pendingNotExist--- Owner Share * ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Plot Details

Plot No. *

Total Area *

Classification

North Boundaries

Is Plot Required? *

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---pendingNotExist--- Total Area * ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Classification

North Boundaries

---pendingNotExist--- Is Plot Required? *

Yes

No

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Declarartion

I hereby declare that the above details are true and correct to the best of my knowledge. Also, I undertake that if anything is found untrue, I shall be liable for punishment/penalty as per law. I do hereby give my consent to the usage of my identity details by the authorities for verification and communication purpose.

I Agree *