FORM A [See Rule 32] Nowkarnama 1. District : 2. Taluk : 3. Village : 4. Name of the shop, number of the licence and date : 5. Name of the licensee : 6. Name of the agent or servant authorised to be incharge with father's name and address : 7. Identification marks of the agent or servant : 8. Signature or thumb impression of the agent or servant : 9. Signature of the licensee : (Seal) Place : Date : Signature of the issuing authority
