GOVERNMENT OF PONDICHERRY DEPARTMENT OF AGRICULTURE FORM A (See Clause 4) FORM OF APPLICATION TO OBTAIN DEALER LICENCE IN SEEDS To, The Registering Authority State of/Union Territory of Pondicherry 1. Full name and address of the ... applicant (a) Name and postal address ... (b) Place of business (Please give exact address) 1. For sale 2. For storage 2. Is it a proprietary/partnership/ limited company/ Hindu undivided family concern? Give the name (s) ... and address(es) of proprietary/partners/ manager/ karta. 3. In what capacity this application is made (i) Proprietor (ii) Partner (iii) Manager (iv) Karta 4. Was the applicant ever convicted under the Essential Commodities Act, 1955 (10 of 1955) or any order issued thereunder during the last three years preceding the date of application? If so, give details. 5. Give the details of seed to be handled Sl. No. Name of seed 6. I/ we have deposited the licence fee of rupees fifty vide chalan No. Dated in Treasury /Bank DECLARATION 1. I/We declare that information given about is true to the best of my/our knowledge and belief and no part thereof is false. 2. I/We have carefully read the terms and conditions of licence given in FormB, appended to the Seeds (Control), 1983 and agree to abide by them. Place: Date: Signature of applicant. Note: Where the business of selling / exporting / importing seeds is intended to be carried on at more than one place, a separate licence should be obtained for each such place. (For use in the Office of Licensing Authority) Date of receipt: Name and designation of officer receiving the application.
