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 Mixture of Fertilizers To The Controller Registering Authority, Place...... State of.... 1. Full Name and address of the applicant: 2. Does the applicant possess the qualifications prescribed by the State Government under sub-clause (I) of CI. 14 of the Fertiliser Control Order, 1985: 3. Name and address of the person requiring the special mixture of fertilizers: 4. Particulars of certificate of manufacture already obtained from the same Registering Authority: 5. Situation of the applicant's premises where fertilizer are/will be mixed: 6. Full particulars regarding chemical analysis of the special mixture of fertilizers required to be manufactured and the materials used in making the special mixture: 7. I am enclosing an attested copy of the requisition made by the purchaser of the special mixture of fertilizers. 8. I have deposited the prescribed registration certificate fee: (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 C appended to the Fertiliser (Control) Order, 1985 and agree to abide by them. ( c) I/We declare that the 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:
