SCHEDULE II (See Clause 4 (1) FORM A The Kerala food Grains Dealers Licensing Order. 1967. Application for Grant / Renewal of Licence 1. Applicant's Name 2. Applicant's Profession 3. Applicant's residence 4. Situation of applicant's place of business with particulars as to No. of house, Street and ward Village or town and District. 5. How long has the applicant been trading in food grains ? 6. Did the applicant hold a food grains licence on any previous occasion ? (if so give particulars including is suspension or cancellation if any) 7. Quality of foodgrains likely to be handed during the current year. 8. Quantities of each foodgrains handed annually during the last three years 1........................................... 2........................................... 3........................................... 9. The availability of finance for carrying on this trade. 10. Income tax and sales tax paid by the applicant in the two years proceeding the year of application (to be indicated seperately for each tax for each year) 1) 2) 11. (a) Quantity of foodgrains in the possesstion of applicant on the date of application (seperate figures are to be given for each food grains) are proposed to be stored 12. Whether the applicant want a licence as a wholesaler or retailer. 13. No. and date of chalan and Name of the treasury in to which licence fee of has been remitted. 14. Whether there is any other whole sale Depot in the applicant's name or in the name of his relative or whether the applicant is partner of any firm for which a licence issued under the Kerala foodgrains Dealers licensing order 1967. I declare that the quantities of foodgrains specified above are in my possession this day and are held and are held at the places noted above. I have carefully read the conditions of licence given form '9' appended to the Kerala Foodgrains Dealers Licensing Order 1967 and I agree to abide by them. (a) I have not previously applied for such licence in this District for foodgrains (b) I have applied for such licence in this District for .......................... .................................................. on .................................................. and was not granted a licence on ..................................................... (c) I hereby apply for renewal of licence No.......................................... dated .............................issued to me on........................................... Place : Signature of the applicant Date : Strike out the clauses not applicable.
