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Application for Permission to Divert Land for-

"Residential or Agricultural purpose" to "Commercial or Industrial purpose"

Entrepreneur Details:

1. Name of the Entrepreneur / Authorized Representative:

2. Entrepreneur Address:

3. Mobile No:

4. Email Id:

Enterprise Details:

5. Enterprise Name:

6. Enterprise Address:

Location Details:

a. District:

b. Tehsil:

c. Village:

d. Survey Number:

Land Details:

7. Land used for:

8. Exisiting Land:

9. Commercial / Enterprise Land:

10. Remaining Area of Land:

11. The Land adjacent to holding is used for:

Declaration

This is to certify that the information furnished is true and correct to the best of my knowledge and belief.

S.No	Department	Office Address
1	DC Office	Office of the Deputy Commissioner (District of South Andaman)

S.No	Nodal Officer	Phone Number	Email Id	Address
1	Assistant Commissioner (HQ)	03192-237825	eodb_and.achqsa@gov.in	Office of the Deputy Commissioner (District of South Andaman)

S.No	Service Name	Name of the Documents
1	Land Conversion	Record of Rights Form 'F' Identity Proof Performa of details of Construction of Building around Port Blair Airport, Appendix I, IIA, IIB, IIC, IID, IIE & C Details of Public Liability Insurance/Policies for the workers handling any hazardous substances (means manufacture, processing, treatment, package, storage, transportation, collection), if applicable Photograph of the Business premises Statutory License to carry business Details of Sewage/Effluent Treatment Plant to be installed, including design, blue print and treatment process & Water balance chart (process consumption, domestic usage, gardening usage, any others, specify), if any
2	Central Sales Tax (CST) Act 1956	Proof of identity such as Electoral photo Identity card/Islander Identity card/ Family Identity card/Passport/local certificate Court fee stamps worth Rs. 25/- Introduction letter from two different CST holders Rent receipt / agreement of the building/premises Statement of Bank account of the applicant 1st inter-state purchase bill and supporting documents Sale bil of the item for which CST has been applied for Item list for which CST has been applied for Distributor ship/dealership certificate, if any Photograph of the Business premises PAN Card

S.No	Forms	Downloads
1	Land Conversion Form	Click to Download
2	Central Sales Tax (Registration & Turnover)- Form A	Click to Download
3	Central Sales Tax (Union Territories) Form -I & II	Click to Download

S.No	Clearance
1	Land Conversion
2	Central Sales Tax (CST) Act 1956

S.No	Service Name	Timelines (in Days)
1	Land Conversion	28
2	Central Sales Tax (CST) Act 1956	30

S.No	Designation	Phone Number	Email Id	Address
1	Deputy Commissioner (South Andaman)	03192-232575	eodb_and.dcsa@gov.in	Office of Deputy Commissioner (District of South Andaman)

S.No	Designation	Phone Number	Email Id	Address
1	Assistant Commissioner (Sub-Divisional Magistrate) & Assistant Commissioner (Disaster Managemen	03192-232575	eodb_and.acsa@gov.in	Office of Deputy Commissioner (District of South Andaman)

S.No	Designation	Phone Number	Email Id	Address

S.No	Designation	Address	Contact	Email Id
1	DEPUTY COMMISSIONER(SOUTH ANDAMAN)	OFFICE OF THE DEPUTY COMMISSIONER(DISTRICT OF SOUTH ANDAMAN)	OFFICE 03192-233089,245444(F), RES 03192-233253, 9434280018	dcand@and.nic.in
2	ADDITIONAL DISTRICT MAGISTRATE(ADM)	OFFICE OF THE DEPUTY COMMISSIONER(DISTRICT OF SOUTH ANDAMAN)	OFFICE 03192-231951	adm@and.nic.in
3	ASSISTANT COMMISSIONER(SUB-DIVISIONAL MAGISTRATE)	OFFICE OF THE DEPUTY COMMISSIONER(DISTRICT OF SOUTH ANDAMAN)	OFFICE 03192-232575	sdm@and.nic.in
4	ASSISTANT COMMISSIONER HEAD QUARTERS	OFFICE OF THE DEPUTY COMMISSIONER(DISTRICT OF SOUTH ANDAMAN)	OFFICE 03192-231951	achq@and.nic.in
5	ASSISTANT COMMISSIONER SETTLEMENT	OFFICE OF THE SUB-DIVISIONAL MAGISTRATE	OFF-232229, WILL:- 201007 OFFICE:- 231951	acset@and.nic.in
6	TEHSILDAR(SPECIAL DUTY)	OFFICE OF THE DEPUTY COMMISSIONER(DISTRICT OF SOUTH ANDAMAN)	WLL:- 200886	-
7	DEPUTY MANAGER(IT) AND AERO(HEAD QUARTERS)	OFFICE OF THE DEPUTY COMMISSIONER	OFF: 03192-232763	dmit@and.nic.in
8	TEHSILDAR (PORT BLAIR)	OFFICE OF THE TEHSILDAR(PORT BLAIR)	OFF 03192-200927(wll), 9474264111	-
9	TEHSILDAR (FERRARGUNJ)	OFFICE OF THE TEHSILDAR(FERRARGUNJ, SOUTH ANDAMAN)	03192-266301,238881, 231945(F)	-
10	DEPUTY TEHSILDAR (LITTLE ANDAMAN)	OFFICE OF THE TEHSILDAR(LITTLE ANDAMAN)	OFF 03192-284216,03192-284249, 201435(WLL) Mobile:- 9434274351	-
11	TEHSILDAR (LAND RECORDS) & TEHSILDAR (ELECTION)	OFFICE OF THE DEPUTY COMMISSIONER, SOUTH ANDAMAN	OFFICE 03192-237749 WLL-200889, 9434283055	-
12	TEHSILDAR(SETTLEMENT-1)	SETTLEMENT SECTION DC-OFFICE	OFFICE 03192- 237749, 9434284401	-