I. DETAILS OF THE LAND OWNER
Name:
Father’s / Husband’s Name:
Address: Vill - , P.O - , P.S – , City – , Dist – , Pin – .
Mobile No.: Aadhaar No.:
Land Record Details: Mouza: JL No.: Khatian No:
Plot No.: Total Area (Ha):
II. DETAILS OF THE TENANT / SHARE CROPPER
Name:
Father’s / Husband’s Name:
Address: Vill - , P.O - , P.S – , District – , Pin –
Mobile No.: Aadhaar No.:
III. PURPOSE OF THE AGREEMENT
This agreement is executed to enable the Tenant / Share Cropper to enroll under Pradhan Mantri Fasal Bima Yojana (PMFBY) only for the crops cultivated by him/her on the land described herein.
IV. DESCRIPTION OF LAND CULTIVATED BY TENANT
| Plot No. |
JL No. |
Mouza / Village |
Area (Ha) |
Crop Sown |
Season |
V. DECLARATION BY LAND OWNER
- I have permitted the above-named Tenant / Share Cropper to cultivate my land described in Section IV for the agricultural season 2026.
- I have no objection to the Tenant enrolling for PMFBY Crop Insurance for the said land.
- I confirm that I will not separately claim insurance benefit for the same land / same season.
- The cultivation rights given to the tenant are genuine and valid for the said season.
- This agreement is executed voluntarily and without any coercion.
Signature of Land Owner:
Date: _____ / _____ / 2026
VI. DECLARATION BY TENANT / SHARE CROPPER
- I am cultivating the above land of my own effort and at my own cost for the 2026 season.
- I am applying for PMFBY Crop Insurance for the land described.
- All information furnished by me is true and correct.
- I shall abide by all PMFBY guidelines issued by the Government of India and State Government.
Signature of Tenant:
Date: _____ / _____ / 2026
VII. WITNESSES
1. Witness:
Name:
Address:
Signature:
2. Witness:
Name:
Address:
Signature:
VIII. NOTARY PUBLIC ATTESTATION / CERTIFICATION
[ Seal & Stamp Space
of Notary Public ]
Attested & Certified before me on this day of , 2026.
Signature:
Name:
Registration No.:
Office Address: