FORM 'B' [See Clause 4(1)] PUNJAB COAL CONTROL ORDER, 1972 Application for the Grant/Renewal of License (Retail) under Clause 4(1) 1. Name of applicant (in block letters) ________________________________ 2. Residential address of the applicant ________________________________ ________________________________ 3. If the application is made on the behalf of a firm, an incorporated company or a co-operated society, state the trading name and the names of the proprietors, partners, managing directors as the case may be ________________________________ ________________________________ 4. Exact address of go down or place of business or place of storage. State also the Municipal number, if any ____________________________________ ___________________________ __________ _______ ____ 5. State for how long have you been in coal business ________________________________ 6. Have you or any of your partners ever been prosecuted for a brench of any Control Order ? Give particulars in brief __________________________________________________________________________________________________________________________________________________________________________________________ I hereby apply for renewal of license No._____________, dated ______________, issued to me on ________________________. I solemnly declare that the above particulars are correct to the best of my knowledge and belief. Signature of Applicant. To The District Magistrate, __________________ __________________
