Schedule 5A [See rule 12 (2) FORM LD-1 [Application Form for licence as Dealer in Weights, Measures, Weighing Instruments and Measuring Instruments under the Standards of Weights and Measures (Enforcement) Act, 1985] To SI No. Commodity To be filledin by theapplicants Comments of the Inspecting Officer (1) (2) (3) (4) 1. Name of the establishment/ : shop/person seeking the licence 2. Complete address of the : establishment, etc. 3. Date of establishment : 4. Name (s) and address (es) of : proprietor (s) and/or partners, and managing directors in the case of Limited Company 5. Number and date of current : Municipal Trade Licence 6. Category of articles sold at : present 7. Sales Tax Registration : Number (1) (2) (3) (4) 8. Do you intend to import weights, etc., from places outside the State ? If so, indicate sources of supply....... (Give details of Manufacturer's trade mark/monogram : and his licence number) 9. Have you ever applied for a : dealer's licence either in this State or else where? If so, give details To be certified by the applicants Certified that I/We have read the standards of Weights and Measures (Enforcement) Act, 1985 and the Standards of Weights and Measures (Enforcement) Rules, 1980, and agree to abide by the same as well as, the administrative orders and instruction issued or to be issued therenumber. I/We agree to deposit the scheduled licence fees with government as soon as required to do so by the Licensing Authority. All the information furnished above is true to the best of my/our knowledge. Place : Date : Signature and Designation. To be filled by the Departmental Officer of the State Government Date of receipt of application ....................................................................... Serial Number of application ........................................................................ Date of inspection ......................................................................................... Recommendation of Inspecting Officer. Signature and Disignation of the Inspecting Officer. Final Orders of Licensing Authority Licence granted/refused Licence No. Date : Valid till : Place : Signature of Controller of Date : Legal Metrology. 6.
