FERTILISER (CONTROL) ORDER, 1985 EMBLEM FORM C (See CI.11) Application for renewal of the Certificate of Registration to carry on the Business of Selling Fertilisers in Retail/Wholesale (for industrial use) To The Registering Authority 1 I/Controller (If the application for industrial dealer's Certificate of Registration) Place.......... State........ I/we hereby apply for renewal of the certificate of registration to carry on the business of selling fertilizers in retail/wholesale 1 [for industrial use] under the name and style of .........The certificate of registration desired to be renewed was granted by Registering Authority/Controller for the.......(mention place and State) and allotted Registration Certificate No........on the......day of.......2000. 2.(i) I/We hereby declare that the situation of my/our premises where fertilizers are (a) stored and (b) sold is as stated below:- (a) (b) Premises where fertilizers Premises where fertilizers are stored are stored (ii) I/We hereby declare that the fertilizer(s) in which I/We am/are carrying on the business of selling and the name(s). Commodity Board(s). State Government(s) and wholesale dealer whom I/We represent are as stated below: (a) (b) Names of fertilizers Names of manufacturers Commodity Boards Wholesale dealers 3. I/we enclose a certificate of source from the manufacturer(s), Commodity Board(s), State Government(s), Wholesale Dealer(s). Whom I/We represent or intend to represent and from whom fertilizers will be obtained by me/us. 4. I have deposited the renewal fee of Rs......vide Challan No.....dated......in. Treasury/Bank......or I enclose the Demand Draft No. dated.......for Rs....drawn on Bank, in favour of......payable at....towards renewal fee. (Please strike out whichever is not applicable). Full name and address of the applicants (in block letters) Signature of applicant(s) Date : Place : Certified that the certificate of registration bearing number.....granted on for the period from.......to carry on the business of selling fertilizer in retail/wholesale of industrial use at the premises situated at .......is herby renewed till the........unless previously suspended or cancelled under the provisions of the provisions of the fertilizer (Control) Order, 1985. (a) (b) (c) (d) Location of Location of Names of fertilizers Names of manu- sale depot godowns attached fertilizers for which facturers. Com- to sale depot, where certificate of register- modity Boards. Fertilizer will be ation is renewed State Governme- stored nts . Wholesale Dealers whom the dealer, represents
