FORM 'E' [See Clause 14(2) (b)] FORM OF APPLICATION TO OBTAIN A CERTIFICATE OF MANUFACTURE FOR SPECIAL MIXTURE OF FERTILISERS To, The Registering Authority Place.................. State........................... (1) Full name and address of the applicant; (2) Does the applicant possess qualifications prescriibed by the State Government under subclause (1) of 14 of the Fertiliser (control) Order, 1985. (3) Name and address of the person requiring the special mixture of fertilisers: (4) Particulars of certificate(s) of manufacture already obtained from the same Registering Authority: (5) Situation of the applicant's premises where fertilisers are/will be mixed. (6) Full particulars regarding chemical analysis of the special mixture of fertilisers required to be manufactured and the materials used in making the special mixture. (7) I am enclosing an attested copy of the requisition mamde by the purchaser of the special mixture of fertilisers; (8) I have deposited the prescribed registraion certificate fee; Declaration: (a) I/we declare that the information given above is trueand correct to the best of my/our knowledge and belief, and on part thereof is false. (b) I/we have carefully read the terms and conditions of the certificate of manufacture given in form 'G' appended to the fertiliser (Control) Order 1985 and agree to abide by them. (c) I/we declare that the special mixture for which a certificate of manufacture is applied for, shall be prepared by me/us or by a person having such qualification as may be prescribed by the State Government from time to time, or by any other person under my/our direction, supervision and control or under the direction, supervision and control of a person having the said qualifications. *(d) I/we declare that the requiste laboratory facility specified by the Controller under this Order is possessed by me/us. Name and Address of the applicant(s) Signature of the applicant(s) Date : Place :
