(FORM-IV) APPLICATION FOR RENEWAL OF LICENCE TO MANUFACTURE INSECTICIDES (Rule-9(I)) 1. I/we .........of ........hereby apply for the renewal of the licence to manufacture insecticides on the premises situated at.........(Licence No. and date to be given). 2. The other details regarding the manufacture of the insecticide continue to remain the same. 3. Particulars of the fee deposited. 4. The licence is enclosed herewith. Date....... Signature..... Verification I......S/o.......do herby solemnly verify that what is stated above is true and correct to the best of my knowledge and belief I further declare that I am making this application in my capacity as.....(designation) and that I am competent to make this application and verify it by virtue of...a photo/attested copy of which is enclosed . Signature with Seal Place:.... Date... *If there is any change in the details of manufacture or conditions of licence subject to which the licence is required to be renewed, the same may be indicated here.
