APPENDIX A

[ under Rule 33 (a) (iii) ]

CERTIFICATE OF ORIGIN REQUIRED FOR PRIVATE TIMBER OR

OTHER FOREST PRODUCE

 

Name,caste,residence
and father's name of
the owner of the land
whence the forest
produce covered by
the certificate was
derived. 		Name of
village or
estate where
the timber
or other forest
produce
was cut.		 Description
of timber or
other forest
produce.		 Amount of timber or other forest produce. Name, caste, father's name and residence pf person in charge of timber or other  forest produce. Destination to which the forest produce is to be conveyed. Remarks
1 2 3 4 5 6 7









           

 

         I .................................................................. son of ......................................................................

of village ......................................................................district ..................................................................

do hereby declare that the forest produce specified in this certificate was cut upon my private land and that
no portion of the said forest produce is the property of the Government or produced on Government land.

.............................                                        Dated,                                     ...................................

   Verifying Officer                              The ................................                      Owner or Agent