1.Name of applicant for license :- ( in full) 2Profession:- 3Full Address 4Father's name in full ( in case of firm, give names and address of partners and person holding powers of attorney to act on behalf of the firm). 5Specific place or places of business 6Financial status with details of persons i.e. Property, Annual Payment of Income Tax and any other relevant evidence regarding financial status 7.Specific purpose for which license is applied for Processing Storing Selling Trading 8Name of the mineral/ore for which license is required. 9Evidence of payment of application fee 10.Name & address of persons/firms from whom the mineral/ores will be purchased/procured. 11Period for which license is required 12In case of renewal the number and date of original license 13Detail of income tax/Sales tax clearance Certificate. 14Any special ground for grant of license in favour of the applicant . List of EnclosersDECLARATION I/we hereby declare that, we have understood all the provisions of the Orissa Mineral (Prevention of theft, smuggling and other unlawful Activities) Act,1989 and Rules made thereunder and the conditions of the licence and, I/we to abide by the same. Date of application Place Signature of the Applicant [See Rule 3 (1) and 8 ] FORM 'A' ( Application for Licence Renewal ) Fromto Published on National Portal of India (india.gov.in) Government of OrissaDepartment of Water Resources
