FORM-IV (See rule 9(1) Application for renewal of licence to manufacture insecticides 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) The other details* regarding the manufacture of the insecticide continue to remain the same. Particulars of the feed deposited: The licence is enclosed herewith Date..................... Signature................................ *If there is any change in the details of manufacture of conditions of licence subject to which the licence is required to be renewed, the same may be indicated here. VERIFICATION I..................................S/o.........................do hereby solemnly verify that what is stated above is true and correct to the best of knowledge and belief. I further declare that I am making this application in my capacity is.....................and that I am competent to make this application and verify, it by virtue of.....................................a photo/attested copy of which is enclosed. Date: Place: Signature with seal
