Manual
› Maharashtra Gram Rakshak Dal Rules, 2017
› FORM - B
Application Form
FORM - B
Application Form for to call Special Gram Sabha to establish Gram Rakshak Dal by Women Voters.
See Rule 3 (2)
What this form is for
Form B is an application asking the Sub-Divisional Magistrate to call a special Gram Sabha for establishing a Gram Rakshak Dal in a village. It is filed by women voters of the village, with their signatures or thumb impressions and witness details, where illegal liquor manufacture and sale is causing harassment of women and social safety problems. The attached list of women voters supports the request, and the Gram Sabha would then consider a resolution to set up the Dal. The form is prescribed under Rule 3 (2) of the Maharashtra Gram Rakshak Dal Rules, 2017.
Form text (extracted)
12 ¨É½þÉ®úɹ]Åõ ¶ÉɺÉxÉ ®úÉVÉ{ÉjÉ +ºÉÉvÉÉ®úhÉ ¦ÉÉMÉ SÉÉ®ú-¤É, ¨ÉÉSÉÇ 22, 2017/SÉèjÉ 1, ¶ÉEäò 1939
Enclosure : Names of Members of the Gram Rakshak Dal Proposed.
Sr. Name Address Sign Name and Signature Remarks
No. of Witness, if the
applicant has establish
thumb impression
(1) (2) (3) (4) (5) (6)
FORM - B
[See Rule 3 (2)]
Application Form for to call Special Gram Sabha to establish Gram Rakshak Dal by
Women Voters.
To,
Sub-Divisional Magistrate,
…............................................
Dist. …...................................
Subject.––To call special Gram Sabha to establish Gram Rakshak Dal.
Dear Sir / Madam,
With reference to above subject you are requested to call a special Gram Sabha to establish a
Gram Rakshak Dal in our Village ...... Tal..... Dist........ The manufacturing and sell of illegal liquor
has results increase misbehaviour of alcoholic persons, harassment of women which creates the
social safety problem. Therefore to prevent it, special Gram Sabha should be called to pass the
resolution to establish a Gram Rakshak Dal under the MaharashtraGram Rakshak Dal Rules,
2017. The list of women voters with signature is attached herewith.
Yours Truly,
Sr. Name Address Sign Name and Sign of Remarks
No. the Witness, if the
applicant has establish
thumb impression
(1) (2) (3) (4) (5) (6)
Original PDF (as scanned from printed manual)