FORM OF STATEMENT REGARDING OWNER/TENANT OF COMMERCIAL AREA/COMPANIES/CLUBS/GOVT.OFFICES (Attach separate document wherever necessary) 1. S.C.F/S.C.O/Booth No __________________________ Sector_____________________________ 2. Owner/Tenant _____________________ If tenant, Name & Address of Owner 3. Name, Address ___________________________________________________ 4. Name of the Shop _________________________________ deals in ________________________________________________________ Telephone/ Fax 5. Having any servant/helper or not? __________________________________ (if yes, fill form-2 also) 6. Detail of persons employed:- No. Name Age Sex Designation Address 1. 2. 3 4 5 6 7 8 Note: 1. Attach separate, if required. 2. In case of any change /addition, please report in respective police Station Certified that the information given above is correct to my Knowledge and belief and that noting has been concealed. Name____________________________ Signature _____________________ Date_________________
