FORM 'A' (Under section 5 (a) of the Andhra Pradesh Cotton Seeds (Regulation of Supply, Distribution, Sale and Fixation of Sale Price) Act, 2007 and rule 13(1) of the Andhra Pradesh Cotton Seeds (Regulation of Supply, Distribution, Sale and Fixation of Sale Price) Rules, 2007) Form of Application to obtain Certificate of Registration at district level To The Registering Authority ................ ................ 1. Full name and address of the Applicant: a. Name and Postal Address: b. Place of business: i. Sale: ii. Storage: 2. Is it a proprietary/partnership/limited Company/Hindu undivided family concern? Give the Name(s) and address(es)of Proprietor/partner/ manager / Karta. 3. In what capacity this application is made: i)Proprietor ii)Partner iii) Manager iv)Karta 4. Was the applicant ever convicted under the Essential Commodities Act, 1955(10 of 1955), or any order issued there under or Environmental Protection Act, 1986 or Andhra Pradesh Cotton Seeds (Regulation of Supply, Distribution, Sale and Fixation of Sale Price) Act, 2007 during the last three years preceding the date of application? If so give details: 5. Give the details of cotton seeds to be handled: S.No Name of variety 6. I/We have remitted the registration fee of rupees five hundred vide Challan No ... dated ...... in treasury/bank ......... 7. Declaration: a) I/We declare that the information give above is true to the best of my/our knowledge and belief and no part thereof is false: b) I/We have carefully read the terms and conditions of Form 'C' appended to the Andhra Pradesh Cotton Seeds (Regulation of Supply, Distribution, Sale and Fixation of Sale Price) Rules, 2007, and agree to abide by them. c) I/We declare that no seed license/certificate of registration granted earlier to me/us has been cancelled /suspended. Place: Date: Signature of Applicant.
