Belpahar Municipality

Name of the Applicant*

Gender of the Applicant*

Male Female

Date of Birth*

Father's Name*

Present Address*

Ward*

Permanent Address

Phone*

Email

Name of the Trade*

Type of Trade*

Purpose of the Trade*

Place/Premises of Trade

Trade Ward*

Holding No.

Khata No.

Revenue Mouza

The place is

Owner Name (If Rented or Leased)

Plinth Area proposed to be utilized for trade (Sq. Ft.)

Working Hours*

Number of workers expected to be engaged*

Is this a residential building?

Yes No

Period for License Required (in Years)

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Trade License