FORM OF APPLICATION FOR PERMIT FOR KEROSENE TO ESTABLISHMENTS 1. Name and address of the applicant : 2. Name of the Establishment with location (Building No., Ward No., Municipality/ Corporation/Panchayat) : 3. Details of license issued by the Corporation/ Municipality/Panchayat : 4. Sales Tax Registration No. : 5. Business turnover for the last three years : 6. Purpose for which kerosene oil is required : 7. Monthly requirement of kerosene oil. DECLARATION I ............................................................................................. do hereby declare that the details furnished above are correct to the best of my knowledge and belief. Place : Signature of the applicant. Date :
