FORM - B APPLICATION FOR RENEWAL OF WHOLESALER/RETAIL LICENCE (For the trade in Paddy & Rice / Wheat & Wheat Products/Pules/Edible Oils & Edible seeds/ Chillies (Dry)/Jaggery/Tamarind) 1. Name of licensee : 2. (a) Wholesale/Retail licence No. : (b) the address of the business place and storage place : (c) whether the business place and storage place are owned or hired or on lease : (d) If on lease, the period for which the lease is valid : (e) If on rent, the period for which it has been taken on rent (agreement copy to be attached) : 3. Date on which the licence expires : 4. Whether penal action taken against the licensee for contravention of the provisions of Tamil Nadu Essential Trade Articles (Regulation of Trade) Order 1984 or the licence issued there under or the essential commodities Act 1955 from the date of issue of the licence till the date of application for renewal : (i) If so the nature of offence : (ii) Punishment inflicted (in the case of forfeiture of security deposit, the challan No., and date in which the forfeited amount was remitted go Government) : (iii) whether he has defaulted in tendering any statutory levy : (iv) whether he has been convicted by a court of law for any offences under the Essential Commodities Act 1955) (Central Act 10 of 1955) or the Tamil Nadu Essential Trade Articles (Regulation of Trade) Order, 1984 : (v) Whether he has been declared as an insolvent? : 5. Details of renewal fee paid : (i) Amount Paid : (ii) Challan No. & Date in which paid : (iii) Treasury in which remitted : (iv) Whether the challan in original is enclosed : I hereby declare that the particulars furnished above are correct to the best of my knowledge and nothing has been concealed therein. Place: Date: SIGNATURE OF THE LICENSEE
