Chandigarh Administration Application For The Grant of License To Sell, Stock or Exhibit For Sale or Distribute Insecticides ToThe Licensing Authority,State of1. Full NameAddress of applicant2. Is the applicant a new comer?3. If yes, the Name of the Principals4. If the applicant has been a) In the trade, give full particulars of the Nameof insecticides handled, the periodPlace at which the trade was carried onAnd the principals who he Representedb) Also give the quantities handled during the : i)Post two calendar years. Ii)5. I enclose a certificate from principals whom I represented or whom I intend to represent and the source /sources from which insecticides will be obtained. 6. Quantities of each insecticides (In tones) in my/ our possession on the date of application ( at the sale depot and in godowns attached there to). 7. Situation of the dealers premises where the insecticides will (a) stored and (b) sold.8. The Names of insecticides in which the applicant desires to carry on business.9. Full particulars of license issued in his Name by othe state Govt's, if any, in there area10. I have deposited the license fee.Treasury Challan No.Sub Treasury Declarationa) I/We declare that the information given above is true to our knowledge and belief and no part there of is false. b) I/We carefully have read the terms and conditions of the license and agree to abide by them. NameAddress of the Applicant in blockPlace :Date:Signature of applicant(Remarks by the Licensing Authority)
