FORM OF APPLICATION FOR LICENCE / RENEWAL OF LICENCE TO ITINERANT VENDORS WHO HAVE NO SPECIFIED PLACE OF BUSINESS TO THE LICENSING AUTHORITY / AND LOCAL (HEALTH) AUTHORITY. I / We ______________________________________________ Son / Daughter / Wife of ____________________________________________ aged _______________sex ___________ Residing at ___________________________by occupation______________________________ apply for a fresh license / renewal of license under the provisions of Food Adulteration Act, 1954 and Rules made there under for the manufacture / sale / preparation exposure for sale storage of the following articles of food and drink : I further declare that the sale of these articles shall be carried out by hawking on a handcraft, within the local area of the Local (Health) Authority within the jurisdiction of the Licensing Authority. I / We shall abide by the provisions of the Prevention of Food Adulteration Act , 1954 and the Rules made there under. I / We are enclosing herewith Medical Certificate(s) in Form - III of my own / our own and also that of my / our employee / employees. The amount of Rs. __________________ is remitted / credited to Government under the Head of Account "0210 - Medical and Public Health , 04 - Public Health, 104 - Fees, fines etc., under PFA Act. Etc. " Dated : SIGNATURE OF THE APPLICANT Specimen Signature of the Applicant : 1. 2. 3. Note: This application form should accompany with The passport size photograph in triplicate.
