Download Form of Application for License / Renewal of License to Manufacture for Sale/ Sell/ Storage for Sale/ Distribution of Wholesale/ Retail - Hyderabad

FORM - I FORM OF APPLICATION FOR LICENSE / RENEWAL OF LICENSE TO MANUFACTURE FOR SALE/ SELL/ STORAGE FOR SALE/ DISTRIBUTION OF WHOLESALE/ RETAIL TO THE LICENCE AUTHORITY/ LOCAL (HEALTH) AUTHORITY I / We ____________________________________________ Son/ Daughter/ Wife of ______________________________ aged _____ sex ______ Residing at ____________________________________________________________________ by occupation____________________________________________________________ apply for a fresh license/ renewal of license under the provisions of the PFA Act 1954 and rules made thereunder for the manufacture for sale/ sell/ storage for sale/ distribution in wholesale/ retail ____________ per day within the limits of local area of the license authority/ authorities of _________________________________________ in the premises situated at ______________________ from the shop. 2. Class of articles of food for which a license is prayed for 3. I/ We shall abide by the provisions of the PFA Act 1954 and the rules made thereunder and carry on the aforesaid trade subject to the restrictions and conditions imposed by the license granted to me/ us. 4. I/ We are enclosing herewith medical certificates(s) in Form -III of my own/ our own and also that my/ our employee/ employees. 5. The amount of Rs. _________ is remitted/ credited to Government under the Head of account "0210 - Medical and Public Health, 04 - Public Health, 104 - Fees, fines etc., under PFA Act. 6. In my/ our absence Shri/ Smt. ____________________________________ Age_________Sex_______,Resident of __________________________________shall conduct the aforesaid business. 7. The statements made above are true to the best of my/ our knowledge and belief, and if anything is found to be false or not true the license shall be liable to be suspended, canelled or forfeited. Note:-In case of Partnership or Limited company or Co-operative Society attested copy of Partnership deed or article of association or Registration certificate issued by the Registrar of Co-operative Society, as the case may be shall accompany the application. Dated: SIGNATURE OF THE APPLICANT Specimen Signature of the Applicant : 1. 2. 3.