EMBLEM FORM - 'A' (See Clause -4) Form of Application to obtain Dealers license To The Registering Authority, ............................... (Place) State of /U.T. of 1. Full name and address of the Applicant: a) Name and Postal Address: b) Place of business(please give exact address): i) for sale ii) for 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 during the last three years preceding the date of application? If so give details: 5. Give the details of seeds to be handled. S.No...................................Name of Seed.... 6. I/We have deposited the license fee of rupees fifty vide Challan No......................dated............. in treasury/bank................................ 7. Declaration: a) 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; b) I/We have carefully read the terms and conditions of the license given in Form `B' appended to the Seeds(Control) Order,1983, and agree to abide by them. Dated: Signature of Applicant Place: NOTE: Where the business of selling/exporting/importing seeds is intended to be carried on at more than one place, a separate license should be obtained for each such place. For use in the office of licensing authority Date of receipt Name and designation of Officer receiving the application
