UP/MAY/EOI/ROPP/01/LLCC

Application for Land on Lease Basis (LOLB) for Bio-Fuel Production Plant.

1 Personal Details

1.1 Name of Applicant : ______________________________________

1.2 Address of Residence : ______________________________________
______________________________________
______________________________________
District : ___________ Pin code : __________

1.3 Address for Communication : ______________________________________

______________________________________
______________________________________
District : ___________ Pin code : __________
Residence with STD code : _________________________
Office with STD code : _________________________
Mobile : _________________________

2 Occupation /Business details

2.1 Current occupation : _____________________________________________________

2.2 Current source of Income : _____________________________________________________
2.3 If Business, Name of firm/s : _____________________________________________________
2.4 Details of Business : _____________________________________________________
2.5 Type of firm (Tick any one) : Proprietorship Partnership Public Ltd. Private Ltd.
2.6 Annual Turnover of firm (in : _________________________
Rupees)

2.7 No. of employees employed : _________________________

2.8 How long have you been in : _________________________
This business? (years /
months)
2.9 Will this proposal be your : Primary source Secondary source
primary or secondary source
Of income? (Tick any one)
2.10 Experience in any other : _____________________________________________________
retail sales (Give details of
products traded e.g. FMCG, _____________________________________________________
pharma, plastic, textiles etc.)

UP/MAY/EOI/ROPP/01/LLCC
 UP/MAY/EOI/ROPP/01/LLCC

3 Industry Experience

3.1 Any previous experience in : Yes No

Production industry?
If yes, please attach separate sheet to provide more details with respect to experience)
3.2 Any family members involved in : Yes No
The production business? If yes,
please attach separate sheet to
provide more details

3.3 If dealing in retail/production/manufacturing of any product, please provide information:

a) Name of the Company : ___________________________________________________
b) Address : ___________________________________________________
___________________________________________________
___________________________________________________
c) Operating since : _________________________

4.0 Site Particulars

4.1 Land available for development : Yes No

a) Site / Location address

Survey No. / Gut no. of plot : ____________________________________________________

Plot/Property address : ____________________________________________________
Village : ______________________________________
Taluka : ______________________________________
District : ______________________________________
National Highway No. : ___________ State Highway No. : _________
Major District Road No. : ___________ City Road No. : _________

b) Site Dimensions

Size of site Length & Width : ________________________ (in Meters)

Frontage of site : ________________________ Meters
Length of plot along the road : ________________________ Meters
Total land area : ________________________ Square Meters
Site plan (Kindly attach sketch of the plot showing dimensions of the plot & also of the road on which plot is situated.)

c) Site within or outside city limits

Distance from nearest city/town : ________________________

UP/MAY/EOI/ROPP/01/LLCC
 UP/MAY/EOI/ROPP/01/LLCC

5 Landmark for the site

5.1 Distance from nearest KM stone : ________________________

from the plot (Mtrs.)
5.2 Description of the KM stone : ________________________
5.3 Nearest road junction : ________________________

6 Other site details

6.1 Name of the Land owner : ____________________________________________________

What is your relationship with : ____________________________________________________
The owner?
6.2 Are all documents related to the : Yes No
Property clear? (Attach copies of
the document)
6.3 Are you willing to give the land / : Yes No
property on long term lease to
(ZPGI)?
6.4 Status of land? : Agriculture Non- Agriculture
(If Agriculture, indicate time to : _________________________ Months
convert for non-agriculture use (If
Required)
6.5 Is the plot / property currently : Yes No
Vacant?
(If no, indicate time required to : _________________________ Months
get the site completely vacant)
6.6 Is Power connection readily : Yes No
Available?
(If no, indicate time required to : _________________________ Months
get the power connection)
6.7 Is there any electrical installation : Yes No
Passing over site?
If yes : High tension Low tension

6.8 Is water connection readily : Yes No

Available?
(If no, indicate time required to : _________________________ Months
get the water supply)

UP/MAY/EOI/ROPP/01/LLCC
 UP/MAY/EOI/ROPP/01/LLCC

7 Financial details
7.1 Name of your bank/s : ____________________________________________________
7.2 Branch : ____________________________________________________
7.3 Address : ____________________________________________________
7.4 Account type : _______________________________________
7.5 Account no. : _______________________________________
7.6 Are you an Indian resident? : Yes No
If No, give details : ____________________________________________________

UP/MAY/EOI/ROPP/01/LLCC
 UP/MAY/EOI/ROPP/01/LLCC

Acknowledgment Slip
(Customer Copy)

Received from____________________________________________________________

a sum of Rupees 5000/- (Five Thousand Only) Vide Demand Draft No.______________

Dated ________________ Drawn on bank

___________________________________________ Branch

________________________ for application for Land on Lease Basis (LOLB) For Bio-Fuel

Production Plant.

Note: Demand Draft Should Be Made In Favor of “ZEVIK PETROLEUM AND GAS

INDUSTRIES” Payable at Noida.

From on Behalf of,

Zevik Petroleum & Gas Industries

Chief Secretory,
Selection Committee,
Office of Selection Committee & Administrative,
Zevik Petroleum & Gas Industries
B-8, Industrial Area, Unit No. C - 305,
Noida One, Sector 62,
Noida - 201309 (Uttar Pradesh)

UP/MAY/EOI/ROPP/01/LLCC