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Insecticides Rules, 1971

FORM VII
[Rule 10(1)]

APPLICATION FOR RENEWAL OF THE LICENCE TO SELL, STOCK OR EXHIBIT FOR SALE OR DISTRIBUTE INSECTICIDES

To
The Licence Authority
State of_______________

I/we hereby apply for renewal of the licence to sell, stock or exhibit for sale or distribute insecticides under the name and style of __________________. The licence desired to be renewed was granted by the licensing authority for state of __________________ and allotted licence No._____________ on the _______________day of ______________20 .

The situation of the applicant#$#s premises where the insecticides are / will be-

(a) stored and (b) sold

(i) I/we hereby declare that the situation of my /our premises where the insecticides are stored, and (b) sold, as stated below;

(a)_____________________________

(b) ___________________________

premises where insecticides are stored / Premises where insecticides are sold.

(ii) the insecticides in which I/we am/are carrying on business and the name of the principals whom I / we represent are as stated below :

full name and address of the applicant in block letters

_________________________________________________________

Date:_____________________
Place:_____________________

Signature of applicant(s)______________

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