EMBLEM FORM 'A' (See Clause 4) FORM OF APPLICATION TO OBTAIN DEALER'S LICENCE To The Registering Authority, _________________________(Place) State of Punjab. 1. Full Name and address of the applicant: (a) Name and Postal Address: (b) Place of business (Please give exact address): i) For sale: ii) For Storage: 2. Is it a Proprietary/Partnership/Limited Company/Hindu undivided family conern? (Give the name(s) and address(s) of Proprietor/Partner/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 there-under during the last three years preceding the date of application? If so, give details. 5. Give the details of seeds to be handled: S.No. Name of Seed 6. I/We have deposited the Licence Fee of Rupees Fifty vide Challan No._________________ dated ____________________ in Treasury/Bank ________________________________. 7. Declaration: (a) I/We declare that the information given above is true to the best of my/our knowledge and belief and no part thereof is false. (b) I/We have carefully read the terms and conditions of the Licence given in Form 'B' appended to the Seeds (Control) Order, 1983 and agree to abide by them. Date: Signature of the Applicant(s) Place: 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 Receiving the application.
