FERTILISER (CONTROL) ORDER, 1985 EMBLEM FORM D (See CIs.14 (2) (a) and 18 (I)) Form of Application to obtain a Certificate of Manufacture of physical granulated Mixture of Fertilizers 2 (***) Renewal To The Controller Registering Authority, Place...... State of.... 1. Full Name and address of the applicant: 2. Does the applicant possess the qualification prescribed by the State Government under sub-clause (I) of CI. 14 of the Fertiliser Control Order, 1985: 3. Is the applicant a new comer? (Say "Yes" or "No"): 4. Situation of the applicant's premises where physical/granulated mixture will be prepared: 5. Full particulars regarding chemical analysis of the physical/granulated mixture of fertilizers (***) for which the certificate is required and the raw materials used in making the mixture: 6. Full particulars of any other certificate of manufacture, if any, issued by any other Registering Authority: 7. How long has the applicant been carrying on the business of preparing physical/ granulated mixture of fertilizers (***). 8. Quantities of each physical/granulated mixture of fertilizer {***} in tonnes in my/our possession on the date of the application and held at different addresses noted against each: 9. ( i )If the applicant has been carrying on the business of preparing physical/granulated mixture of fertilizer (***) give all particulars of such mixture handled, the period and the places at which the mixing of fertilizers was done: (ii) Also give the quantities of physical/granulated fertilizer mixture handled during the past calendar year: 10. If the application is for renewal, indicate briefly why the original certificate could not be attached on within the period of its validity: 11. I have deposited the prescribed registration certificate fee/renewal fee: Declaration: (a) I/We declare that the information given above is true and correct 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 certificate of manufacture given in Form F appended to the Fertiliser (Control) Order, 1985 and agree to abide by them. (c) I/We declare that the physical/granulated mixture for which certificate of manufacture is applied for shall be prepared by me/ us or by a person having such qualifications as may be prescribed by the State Government from time to time or by any other person under my/our direction, supervision and control or under the direction, supervision and control of person having the said qualifications. (d) I/We declare that the requisite laboratory facility specified by the controller under this order is possessed by me/us. Name and address of applicant in block letters: Signature of the applicant(s) Date: Place:
