Form No.1-A APPLICATION FOR A LICENSE TO DISTRIBUTE/SELL SILKWORM SEED (Cross Bread Disease Free Laying) 1. Name of the applicant : 2 Educational qualifications : 3. Father name : 4. SC/ST/BC/Others(Specialy caste) : 5. Address : 6. Quantity proposed to be handled each time : 7. Source of procurement of silk worm seed (CBDFLS) : 8. Area of operation : 9. Experience in sericulture : 10. Is the application for renewal or for issue of fresh license (if for : renewal, mention previous license number and date of expire) : 11. Amount of license fee remitted with challan number to be enclosed) : Place Date Signature of the applicant. For office use: Remarks of recommending officer: Date of inspection: Observations of issuing authority. Name of issuing authority: Signature with seal: Designation: For use by licensing authority 1. License granted : 2. License renewal : . 3. License rejected. : PLACE: Signature with seal: Date : Name: Designation:
