No ...... Asansol Municipal Corporation Fix 1 Rupee Application For Certificate of Enlist ment Court Fee For Trade Professions & Callings Stamp (U/S 123 of A.M.C., Act. 1990) (Renewal/ New) Rs. 10/ To, The Chief Executive Officer Asansol Municipal Corporation Asansol Sir, I/ We hereby apply for a new/ renewal of Certificate of Enlistment for carrying the trade as stated below. 1. Name of the applicant : __________________________________________ 2. S/o. W/o. D/o. : __________________________________________ 3. Nature of Trade : __________________________________________ 4. Name of the Firm/ Company : __________________________________________ 5. Place of business Name of the : __________________________________________ Street, Lane etc, Ward No. __________________________________________ And Holding No. __________________________________________ 6. Residential address of the : __________________________________________ applicant(s) __________________________________________ 7. Documentary evidence enclosed and : __________________________________________ Rent receipt, N.O.C., from __________________________________________ house owner etc. I/ We solemnly declare that: i) There is no dispute / court case in above mentioned premises where I/ we are conducting the said business. ii) All information and statement are true to my/ our knowledge and belief. Kindly issue Certificate of Enlistment for the year ___________________ on payment of required fee. Dated: The _____________________ Yours faithfully, For Office use Department report: (To be filled by the applicant) No ...... 1. Name of the applicant : 2. Nature of business : 3. Name of the Firm/ Company : 4. Place of business : 5. Ward No. : Dated: The ___________________ 20 Signature of the Receiving Clerk Downloaded from www.asansolmycity.com
