(Rs. 5/- to be paid during submission of this Application Form) For the period 4. The premises are ready for inspection /will be ready for inspection AGARTALA MUNICIPAL COUNCIL Form I Sec, II (I) The prevention of Food Adulteration Act 1954(37 of 1954) (Fillable Form For Licence Under P.F.A, / Rule) (This form is to be submitted in the Head Office -Public Health Section) I/We Son/Sons of Resident of by occupation partners / proprietors Messer's hereby apply for license /renewal of license /amendment of license for the manufacture for sale /storage for sale / for the distribution of articles of food specified below in the premises situated at in the area of 2. The sale of the article of food will be under the personal supervision of a) Name Son of resident of c) Name Son of resident of 3. Classes of articles of food for which a license is prayed for: a) b) 5. The old license No. if any : I/We undertake to comply with the conditions applicable to the license Date: - Signature b) Name Son of resident of of to
