[See Rule 10(1)]
APPLICATION FOR THE GRANT OF LICENCE TO SELL, STOCK OR EXHIBIT FOR SALE OR
The Licensing authority,
State of _______________
1. Full name and address of the applicant.____________________________
2. Is the applicant a newcomer(Say "Yes" or " No")___________________
3. If yes, the name of the principals, if any, whom he represent ____________
5. I enclose a certificate from the principals whom I represent or whom I intend
to represent and the source/ sources from which insecticides will be obtained.
7. Situation of the dealerís premises where the insecticide will be (a) stored; and
8. The names of the insecticides in which the applicant desires to carry on
9. Full particulars of licence issued in his name by other state government, if any,
in their area.
10. I have deposited the licence fee._________________________________
Treasury challan No._____________
11. Declaration :
a. I/we declare that the information given above is true of my /our
knowledge and belief, and no part thereof is false.
b. I/we carefully have read the terms and condition of the licence and agree
to abide by them.
Name and address of the applicant(s) in block letters.
Signature of the applicant.___________________
Remarks by the Licencing Authority
APPLICATION FOR THE GRANT OF LICENCE TO STOCK AND USE RESTRICTED INSECTICIDE(S) FOR COMMERCIAL PEST CONTROL OPERATION(S)
The licensing authority,
1. Full name of the applicant (block letters):
1. registered office:
2. zonal office:
3. premises for which applications is made:
3. is the applicant already in business or newcomer:
4. qualification of responsible technical person:
1. educational qualification:
2. training in pest control operations
3. experience in using restricted insecticide (s) (Attach proof in respect of claims)______________________________________
5. if in the trade, give full particulars of the names of restricted insecticide(s) handled and categories of operation undertaken, the periods and the place(s) at which the trade was carried on.____________________________________________
[Rule 10 (3A)]
LICENSE TO STOCK AND USE RESTRICTED INSECTICIDE(S) FOR COMMERCIAL PEST CONTROL OPERATIONS
1. ____________________ is hereby licensed to stock restricted insecticides viz., ____________________ on the premises situated at ________________ and carry out commercial pest insecticides act, 1968 and the rules there under.