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Annexure IV & XV · e-Mitra Kiosk
Kiosk Owner, Landlord & Applicant Declaration
Consent-cum-affidavit information required for new e-Mitra Kiosk ID creation and premises registration.
01
Kiosk Owner Details
Title
*
Select title
Shri
Smt.
Kumari
Dr.
Kiosk Owner Name
*
Relation Type
*
Select relation
Son
Daughter
Wife
Husband
Father / Spouse Name
*
Jan Aadhaar No.
*
SSO ID
*
Mobile Number
*
Email
Owner's Residential Address
*
02
Kiosk Premises Details
Kiosk Address
*
Premises Type
*
Select premises type
Own Premises
Rented Premises
Leased Premises
Family Premises
Residing Since
*
03
Landlord Details — Annexure XV
Landlord Title
Select title
Shri
Smt.
Kumari
Dr.
Landlord Name
Landlord Relation Type
Select relation
S/o
D/o
W/o
H/o
Landlord Father's Name
Mobile Number
Email
Property Owned Since
Landlord Address
Property Status
Select status
Lawful Owner
Co-owner
Authorised Occupant
Legal Heir
Declaration Preview:
I,
Shri/Smt.
landlord name
S/o
father's name
hereby declare that I am the
lawful owner
of the below-described property and have no objection to it being used as an SSO / e-Mitra kiosk.
04
Property Details
Property Category
Select category
Residential Property
Commercial Property
Mixed Use Property
Address Line 1
Address Line 2
City / Town
District
Select District
Hanumangarh
Shri Ganganagar
Churu
PIN Code
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