FORM OF APPLICATION TO OBTAIN A CERTIFICATE OF MANUFACTURE OF PHYSICAL/GRANULATED MIXTURE OF FERTILISERS OR ORGANIC FERTILISER / BIO FERTILISER To The Registering Authority Place _______________ State of _____________ (1) Full name and address of the applicant (2) Does the applicant possess the qualification prescribed by the State Government under sub clause (1) of Clause 14 of the Fertiliser Control under, 1985. (3) Is the applicant a new comer ? (Say 'Yes' or 'No' ) (4) Situation of the applicant's premises where physical / granulated mixture organic fertilizer / Bio fertiliser will be prepared: (5) Full particulars regarding specifications of the physical/granulated mixture of fertilizers/ organic fertiliser/ Bio fertilizer for which the Certificate is required and the raw materials used in making the mixture. (6) Full particulars of any other Certificate of manufacture, if any, issued by any other Registering Authority: (7) How long has the applicant been carrying on the business of preparing physical/ granulated mixture of fertilizers/ organic Fertilizers/ Bio fertilizer/ mixture of micronutrient fertilizers ? (8) Quantities of each physical/granulated mixture of fertilizers/mixture of micronutrient fertilizers/ organic fertilizers/ Bio fertilizers (in tonnes) in my/our possession on the date of the application and held at different addresses noted against each ; (9) (i) If the applicant has been carrying on the business of preparing physical/ granulated mixtures of fertilizers/ Mixture of micronutrient fertilizers/ organic fertilizers/ Bio Fertilizers, give all particulars of such mixtures handled, the period and the place (s) at which the mixing of fertilizers wad done; (ii) Also give the quantities of physical/ granulated fertiliser mixture organic fertiliser/Bio fertilizer handled during the past calendar year; (10) If the application is for renewal, indicate briefly why the original certificate could not be acted on within the period of its validity. Declaration (a) I have deposited the prescribed registration certificate fee/ renewal fee. (b) I/we declare that the information given above is true and correct to the best of my/our knowledge and belief, and no part there is false. (c) I/we have carefully read the terms and conditions of the Certificate of manufacture given in Form F appended to the Fertiliser(Control) order, 1985 and agree to abide by them. (d) I/we declare that the physical/granulated mixture/organic fertiliser/Bio fertilizer for which certificate of manufacture is applied for shall be prepared by me/us or by a person having such qualifications as may be prescribed by the State Government from time to time or by any other person under my/our direction, supervision and control or under the direction, supervision and control of person having the said qualification. (e) I/we declare that the requisite laboratory facility specified by the Controller, under this order is possessed by me/us. Name and address of applicant in block letter. Signature of the Applicant(s) Date: Place: Check List for granting of fresh Manufacturing licence of Biofertilizers / Organic Fertilizers 1. Request application from the unit: 2. Form D 3. Challan of Rs. 1000/- under Head of Account 0401 - Crop Husbandry 800 -Other receipts 81 Other Items 4. Bio-data of the chemist 1. Appointment order 2. Willingness to work 3. Degree certificate 5. List of machinery available in the laboratory and its working condition should be certified by the concerned Joint Director of Agriculture 6. SSI Certificate in case of Bio-fertilizer. 7. Name of responsible person with the following details. 1. Name: 2. Father's Name: 3. Age: 4. Designation: 5. Permanent address: 6. Local Address: 8. Inspection report of the Joint Director of Agriculture concerned. 9. VAT Registration No. 10.. The applicant should apply to Registering authority ( Commissioner & Director of Agriculture) and the same should be routed through Asst. Director of Agriculture and JDA FORM 'A1' MEMORANDAM OF INTIMATION [See Clause 8(2)] APPLICATION FORM FOR MARKETING PERMISSION OF BIO- FERTILIZERS / ORGANIC FERTILIZERS 1. Details of the Notified Authority to when application is submitted Designation of notified Authority_______________________________ Place ______________________________________________________ State ______________________________________________________ 2. Details of applicant 3. Place of business (Please give full details) i. For sale ii. For storage 4. Whether the application is for a. Name of applicant b. Name of the concern c. Postal address and Telephone number Manufacturer Importer Pool handling agency Wholesale dealer Retail dealer [ Tick mark whichever is applicable] 5. Details of the Fertilizers and their source in Form "O" Name of the Fertilizer Whether Certificate of source in form "O" is attached 1) YES NO 2) YES NO 3) YES NO [Please tick mark which ever is applicable] 6. I have deposited the registration fee for Rs............... vide challan No........ dated..........in the Bank/Treasury ............. or enclose Demand Draft No.........dated........ for Rs...................drawn on............in favour of ................payable at ...........towards registration fees. 7. Whether the intimation is for an authorization letter or a renewal thereof. (Note: In case the intimation is for renewal of authorization letter, the acknowledgement in Form A2 should be submitted for necessary endorsement thereon.) 8. Any other relevant information. I have read the terms and conditions of eligibility for submission of Memorandum of Intimation and undertake that the same will be complied by me and in token of the same, I have signed the same and is enclosed herewith. Date: Place: Signature of applicant TERMS AND CONDITION OF AUTHORISATION 1) I Shall comply with the provision of the Fertilizer(control) order, 1985 and the notification issued there under for the time being in force. 2) I shall from time to time report to the Notified Authority and inform about change in the premises of sale depot and godown attached to sale depot 3) I shall also submit intime all the returns as may be prescribed by the State Government 4) I shall not sell fertilizers for industrial use. 5) I shall file a separate memorandum of intimation for, where the storage point is located outside the area jurisdiction of the Notified Authority where the sale depot is located. 6) I shall file separate MOI for each place when the business of selling fertilizers is intended to be carried on at more than one place. 7) I shall file separate MOI if I carry on the business of fertilizers both as retail and whole sale dealer. 8) I confirm that my previous certificate of Registration of Authorization is not under Suspension or Cancellation or debarred from selling of fertilizers. DECLARATION I/ We declare that the information given above is true to the best of my/our knowledge and belief and no part thereof is false or no material information has been concealed. Date Place Signature of Applicant(s) Check list - Fresh Marketing license based on Form - O for Bio-fertilizers/ Organic fertilizers 1. Request letter of the firm 2. Application in Form A1 2. Challan of Rs. 2,250/- under the Head of Account for whole sale dealer and Rs. 1250/- in case of Retail dealer. 0401 -Crop Husbandry 800 -Other Receipts 81 -Other Items 4. Latest Form - O issued by the Source of Supplier 5. Inspection report of Sale point or Storage godown if any by the Asst. Director of Agriculture ® concerned. 6. Name of the person responsible with following details Name: Farmers Name: Age: Designation: Permanent Address Local Address: 7. VAT Registration No. 8. The proposals for marketing permission in the entire state should be routed through the concerned ADA to Notified Authority (Addl. DA). 9. The proposals for marketing permission in the ADA jurisdiction should be submitted to him only.
