EMBLEM FORM 'H' [See Clause 23 (1)(b)] Application for grant of permission to Sell Non-Standard Fertilisers To The Registering Authority, State of ............................... (1) Full name and address of the applicant: (2) The name of fertilisers in which the applicant has been authorised to carry on business: (3) Number and date of Registration certificate granted in favour of the applicant: (4) The particulars of non-standard fertilisers which are intended to be sold: (i) Name of the fertiliser: (ii) The source from which the fertilisers were originally purchased and the period during which they have been held by the applicant; (iii) Brief reasons leading to the material having become non-standard; (iv) The chemical specifications as analysed by an authorised chemical laboratory; (v) Name and appearance of the non-standard fertilisers; Note :-Chemical analysis to be indicated shall be one which has been certified by an authorised chemical laboratory on the basis of the sample drawn, sealed and despatched in the presence of the local Inspector of Fertilisers or any body authorised to inspect the fertilisers. I enclose a copy of the certificate of registration for dealing in fertilisers already granted to me and I have deposited the prescribed fee for permission to sell non-standard fertilisers. I certify that I will comply with the requirement of sub-clause (a) of Clause 23 of the Fertiliser (Control) Order, 1985 which requires that each container of non-standard fertilisers is to be conspicuously superscribed with the words 'Non-Standard' and also with the sign 'X' both in red colour. Signature of the Applicant. Name and address of the applicant in block letters. Date : Place :
