FORM (A) (See clause -4) The Punjab Light Diesel Oil & Kerosene Dealers Licensing Order,1978. Application for grant/renewal of wholesale/retail license. To The District Magistrate, __________________, __________________ I/we hereby apply for the grant/renewal of a wholesale/retail license to sell or supply light diesel oil or kerosene or both at (here mention the address or the addresses of the place of business) ____________________________________________________________________________. 1. Name, parentage & postal address of the applicant _____________________________. _________________________________________________________________________. 2. Address & details of the location(s) of the applicant's godown(s)___________________. _________________________________________________________________________. 3. Period for which license is required _________________________________________. I/We declare that I/We have never been convicted for an offence involving moral turpitude. I/We have carefully read the conditions of the license given in FORM (B) & I/We agree to abide by them. I/We hereby declare that all the particulars given on this form are correct. I/We hereby apply for renewal of license number________________, dated __________, Issued to me on __________________. Place_______________________. Date_______________________. Signature of Applicant.
