FORM - I CLAIM UNDER AGRICULTURIST - CUM - RURAL AREA QUOTA

AGRICULTURIST CERTIFICATE This is to certify that Mr. /Ms..…………………………………………….…………… Son / Daughter of……………………………………………..………………………comes from an Agriculturists’ Family. He/She/His/Her parent(s) owns lands as detailed below* Mandal

Village

Patta No./Khata No.

Survey No. Area (In Acres / in Guntas

______________________________________________________________________ *Total Area in words_________________________________

Place : Date :

Office Seal

Signature of Mandal Revenue Officer / Tahsildar