GOVT. OF TRIPURA
PUBLIC WORKS DEPARTMENT (R & B)
APPLICATION FOR ROAD CUTTING PERMISSION

[* The applicant should study carefully the Rules of Enlistment and the list of documents to be annexed with the application form before filling the form. Applications found deficient in any respect are liable to be rejected without any further correspondence ]

Applicant's Details

Nature of Business Entity

Name of the Business Entity *

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Name of Authorized Applicant *

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Father's Name

Aadhaar Number / Virtual Id

DOB

Registration No. issued by Registrar of Companies(ROC) *

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Enlistment Certificate No.

Trade Licence No.

Are you from outside of Tripura ?

Yes

No

Trade License

Trade Name

Trade Address

License No

Issued By

Business Type

Valid till

Partner Details

.

Owner Name / Partner Name

Father's Name

Address

Owner Name / Partner Name

Father's Name

Address

Contact Details

Mobile Number *

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E-Mail *

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Regd. Office Address(Other State)

Other State

Other District

Other Sub-District

Town/Village/Ward No

Flat No. /Street No.

PIN Code

Is Local Office Address same as Regd. Office Address?

Yes

No

Local Office Address

Regd. Office Address

Districts *

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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 Corporation *

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Ward *

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Area Name/ House No. *

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Municipality *

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Ward *

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Area Name/ House No. *

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Nagar Panchayat *

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Ward *

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Area Name/ House No. *

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ADC Block *

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Village Council *

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Habitation *

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Police Station

Quick Post-Office Search

Post Office & Pincode

Is Local Office Address same as Regd. Office Address? *

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Yes

No

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Local Office Address

Location of the Road

District *

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Revenue Sub-Division *

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PWD Division / Office to Apply *

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Quick Search Road Name

Name of Road

Service Specific Information

Category of Road

Chainage From (Meter)

Chainage To (Meter)

Width (meter)

Length (metre)

Permission for Laying of

Method of Laying

Location of laying cable

Number of Existing Lanes

Proposal to lay cable is between

Service Road Existing

Yes

No

If Yes, then Select

Power of Attorney(PoA) Details

Name of the person holding PoA

Liabilities Note: Please indicate the present liability of the company including unpaid bank loan.

PoA Registration No.

Issue Date

Road Location

Road Name

Supporting Document/Certificates

1. Power of Attorney or Authorization Letter from all partners/ directors authorizing the applicant.

Yes

No

2. Trade License/Registration Certificate of the Authorization Contractor/Business Entity.

Yes

No

3. Lay out plan

Yes

No

4. Methodology of Laying OFC.

Yes

No

Declaration/ Undertaking to be submitted by the Applicant

1. No damage to other utility, if damaged then, to pay the loss to PWD or concerned agency.

2. Renewal of Bank Guarantee, if required.

3. Conforming all standard conditions of MORT&H.

4. Shifting of OFC as & when required for widening of road by PWD.

5. Managing of traffic movement during laying of OFC by barricading and cautionary board etc.

6. If any claim raised by concessionaire then the same has to be paid by the applicant,

7. Prior approval of PWD to be obtained before undertaking any work of installation, shifting or repairs or alterations to the underground OFC in RoW.

8. Expenditure, if any, incurred by PWD for repairing any damage caused to state road by laying/ mtc. or shifting of the underground OFC will be borne by the agency.

9. If PWD considers, it necessary in future to move the utility line for any work of implementation or repairs to the road, it will be carried out as desired by PWD at the cost of agency within a reasonable time (not exceeding 60 days).

10. Certification in the Laying of under ground cable will not have any deleterious effect on any of the bridge components and roadways safety for traffic.

11. Applicant will relocate service road/ approach road/ utilities at their own cost notwithstanding the permission granted within such time as well as be stipulated by PWD for future development.

Do you consent to share your email Id and mobile number with Rapid Assessment System developed by Government of India for taking your feedback on the service? Yes/No *

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Yes

No

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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 *

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