FORM - A APPLICATION FOR GRANT OF WHOLESALE/RETAIL LICENCE (For the trade in paddy and rice/wheat and wheat products/pulses/edible oils & edible seeds/Chillies(Dry)/Jaggery/Tamarind) 1. Applicant's particulars: i) Name : ii) Son of : iii) Age : iv) Whether Scheduled Caste or Scheduled Tribe : 2. Residentail Address of applicant i) Door No. : ii) Name of street : iii) Name of Village/Town : iv) Name of Taluk : 3. Name/Style in which licence is required : 4. Situation of applicant's place of business : i) Door No : ii) Name of street : iii) Name of Village/Town : iv) Name of Taluk : 5. If it is a partnership concern, Name of partners: 1. Thiru. son of 2. Thiru. son of 3. Thiru. son of 4. Thiru. son of 5. Thiru. son of 6. Whether the applicant has applied for a wholesale/Retail Licence : 7. Particulars of essential trade articles in which the applicant wants to trade: i) Paddy and Rice : ii) Wheat and Wheat Products : iii) Pulses : iv) Edible Oils & Edible Oil seeds : v) Chillies (Dry) : vi) Jaggery : vii) Tamarind : 8. Did the applicant previously hold a licence of the essential trade articles for which he has now applied for a licence: If so, the following details may be furnished: Name of the Essential Trade Articles Licence Security Deposit (1) (2) Amount Remitted (3) Challan No.& Date (4) Treasury in which remitted (5) 1. 2. 3. 4. 5. 9. How long has the applicant been trading in the essential trade articles for which he has now applied for a licence? : 10. Availability of finance for carrying on the trade : 11. Stocks of essential trade articles in possession on the date of application : 12. Particulars of the place where the essential trade articles for which licence has been applied for are proposed to be stores (with I declare that the particulars mentioned at items 1 to 15 above are true to the best of my knowledge and belief and nothing has been concealed therein. door No. and street name) : (i) Whether the storage place is owned or hired or on lease : (ii) If on rent, period for which the lease is valid : (iii) If on rent, period for which it has been taken on rent : 13. Has the applicant ever been convicted by a court of law for contravention of the provisions of the Essential Commodities Act, 1955 or any other orders issued there under? : 14. In the case of applicants who has previously held a licence the particulars of suspension, or cancellation of the licence if any : 15. Whether the applicant was declared or adjudged as an insolvent by a Court of Law : I have carefully read the provisions of the Tamil Nadu Essential Trade Articles (Regulation of Trade) Order 1984 and the terms and conditions of licence given in form C appended to the said order and I agree to abide by them. Place: Signature of the applicant. Date:
