SCHEDULE II APPLICATION FORM [Clause 3(27)] Form of application for grant of renewal of licence to install a Power Crusher for manufacture of Gur. 1. Name of the Applicant _________________________________ 2. Percentage/Name of the Firm _________________________________ 3. Full Address _________________________________ Village _________________________________ Post-Office _________________________________ Thana _________________________________ Tehsil ________________________________ District _________________________________ 4. Quantity proposed to be crushed for manufacture of gur______Quintals ________________________________ 5. Season for which licence or renewal of licence is applied for _________________________________ 6. Premises or place with name of town or village and tehsil where Power Crusher is proposed to be installed or Used. _________________________________ 7. Number of crushers for which licence is required with their size and capacity to crush cane per day. _________________________________ 8. Number and date of the previous licence in case of renewal _________________________________ Signature of applicant. I/We ____________________________________________________have read the provision of the Haryana Gur Manufacturer's Licensing Order,1972, and understand that licence issued to me/us will be subject to the provisions of the Order and that any breach of the conditions of such licence will amount to a breach of the Order. I/We declare that to the best of my/our information and belief the above information is correct and complete. Signature of the Applicant. Place: Dated:
