FORM'D' [(See Clause 14 (2) (a) & 18 (1)] FORM OF APPLICATION TO OBTAIN A CERTIFICATE OF MANUFACTURE OF PHYSICAL/GRANULATED MIXTURE OF FERTILISERS (S.O.354 (E) dated June 3, 1993) /RENEWAL To, The Registering Authority Place ___________________. State of __________________. (1) Full name and address of the applicant: (2) Does the applicant possess the qualification prescribed by the State Government under subclause (1) of clause 14 of the Fertiliser (Control) Order, 1985: (3) Is the applicant a new comer ? (Say "yes or No"): (4) Situation of the applicant's premises where physical/granulated mixture will be prepared; (5) Full particulars regarding chemical analysis of the physical/ granulated mixture of fertilisers/*for which the certificate is required and the raw materials used in making the mixture; (6) Full particulars of any other certificate of manufacture, if any issued by any other registering Authority; (7) How long has the applicant been carrying on the business of preparing physical/granulated mixture of fertilisers/*mixture of micronutrient fertilisers? (8) Quantities of each physical/granulated mixture of fertilisers/*mixture of micronutrient fertilisers (in tonnes) in my/our possession on the date of the application and held at different addresses noted against each: (9) i. If the applicant has been carrying on the business of preparing physical/granulated mixtures of fertilisers/*mixture of micronutrient fertilisers, give all particulars of such mixtures handled, the period and the place(s) at which the mixing of fertilisers was done: ii. Also give the quantities of physical/granulated fertilliser mixtures handled during the past calendar year: (10) If the application is for renewal, indicate briefly why the original certificate could not be acted on within the period of its validity. (11) I have deposited the prescroded registration certificate fee/renewal fee: Declaration (a) I/we declare that the information given above is true and correct to the best of my/our knowledge and belief, and no part there of is false. (b) I/we have carefully read the terms and conditions of the certificate of manufacture given in Form F appended to the Fertiliser (Control) Order,1985 and agree to abide by them,. (c) I/we declare that the physical/granulated mixture for which certificate of manufacture is applied for shall be prepared by me/us or by a person having such qualifications as may be prescribed by the State Government from time to time or by any other person under my/our direction, supervision and control or under the direction, supervision and control of person having the said qualifications. *(d) I/we declare that the requisite laboratory facility specified by the Controller, under this Order is possessed by me/us. Name and address of applicant in block letters Signature of the applicant(s) Date : Place: *videS.O.No.261 (e) dt. 16.4.1991
