FORM G

(See Rule 9)
APPLICATION FOR RENEWAL OF PERMISSION FOR CONSTRUCTION/RECONSTRUCTION/PERMANENT/TEMPORARY CINEMA

 


To

The Municipal/Corporation Commissioner, The Executive Officer................. Panchayat.


Sir,


1 hereby apply for the grant of renewal of permission for the construction/ reconstruction/of a permanent/temporary Cinema in my favour and give the details as follows:


Signature of the applicant

  1. Full name of the applicant
  2. Permanent address of the applicant
  3. Whether permanent or temporary theatre
  4. Details of the place where the cinema is, under construction/reconstruction

    1. Survey No.
    2. Village
    3. Taluk
    4. District
  5. The reference No. and date and the name of the authority from whom the permission was originally obtained
  6. Whether the permission has been renewed earlier. If so give details of each renewal
  7. State the reasons for the non-completion of the work
  8. Whether fees as prescribed in Rule 19 has been paid and receipt attached. Give details of remittance

Signature of the applicant

 

Place : 

Date :