Government of Odisha
Revenue & Disaster Management Department

FORM No.25

APPLCATION FOR CONVERSION OF AGRICULTURAL LAND FOR NON AGRICULTURAL PURPOSE
All * fields are mandatory
Name of Raiyat :
Father's/Husband's Name :
Present Address
Village/Town :
Address :
District :
State :
Pin :
Email Id:
Mobile :
Specific purpose for which the land will be utlized after conversion:
Particulars of land
District:
Tahasil:
Village:
Khata No :
Classification and status as per current R.O.R :
Whether the land is situated in any area within 0.5 km on either side of National Highway or 0.25 km on either side of state Highways :

Situation of land :



The land is intended to be used /already used for non agricultural purpose:
Source of Ownership:
Approximate market value of the land:
Do you want exemption from payment of conversion Fee as per any state Govt. policy :
I do hereby declare that I have enclosed the relevant documents and indicated the details of land for conversion. I am willing to pay necessary fees as will be determined.
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