Application for copy                                           Urgent / Ordinary

To the District Officer_____________________________________________

Name of the application whom file/Applicant__________________________

___________________________S/o_________________________________

Resident of_____________________________________________________

Post Office and District___________________________________________

Description and number of the case from the record of which the copy is

Required_______________________________________________________

Mauze

P.S.                                                   Goshwara No.

District_________________________________________________________

Name of Parties__________________________________________________

Nature of case__________________________________Date of decision

Order                                       Next date fixed if pending

Name of the court deciding the case or where pending___________________

Date of order etc.                Name of description         Purpose for which of

                                              of the Papers of                is required whether

                                                which copy is                 required for Private

                                                  required                        use or for filing in

                                                                                        same Court etc.

SPACE FOR COURT FEE STAMP

Court fee stamp filed with the application_______________________________

Number_________________________Value____________________________

I Copy to be sent by post or

Will applicant attend in

Person___________________________________________________________

Signature_______________

Date___________________

Order on application________________________________________________

Signature of the copying agent with____________________________________

Date_____________________________________________________________

Signature of recipient of copy with_____________________________________

Date_____________________________________________________________