FORM A The Kerala Hydrogenated Oils (Vanaspathi) and Baby Food Dealers Licensing Order, 1975. Application for Grant/Renewal/Re-issue of Licence. 1. Applicant's Name 2. Applicant's profession 3. Applicant's residence 4. Situation of applicant's place of business with particulars as to number : of house, street and Ward. Village or town and District. 5. How long has the applicant been trading in notified foodstuffs. 6. Did the applicant hold a notified foodstuffs licence on any previous occasion ? ( if so give particulars including its suspension, cancellation if any) 7. Quantities on each items of notified foodstuffs handled annually during the last three years. 1)............................................. 2)............................................. 3)............................................ 8. Quantity of notified foodstuffs likely to be handled during the current year 9. The availability of finance for carrying on this trade. 10. Incometax and saletax paid by the applicant in the two years proceeding the year of application (to be indicated seperately for each tax for each year) 1) 2) 11 (a) Quantity of notified foodstuffs in the possession of the applicant on the date of application (seperate figures are to be given for each item of notified foodstuffs (b) Complete address of places where notified foodstuffs are proposed to be stored. (c) Whether the applicant wants a licence as wholesaler or retailer. I declare that the quantities of notified foodstuffs specified above are in my possession on this day and are held at the place noted above. I have carefully read the conditions of licence given in Form 'B' appended to the Kerala Hydrogenated vegetable oils (Vanaspathi) and Baby Food Dealer's Licencing Order, 1975 and I agree to abide by them. (a) I have not previously applied or such licence in this district for notified foodstruffs. (b) I have applied for such licence in this District for ................... on ..................... and was not granted as licence on ........................ .................................. (c) I hereby apply for renewal of licence No................................... issued on me on....................................... Place : Signature of applicant Date : Strike out the clauses not applicable
