সার ব্যবসার জন্য সরকারী অনুমতি পত্রের দরখাস্ত

FORM 'A1'

*MEMORANDUM OF INTIMATION

[see clause 8(2)]

1.  Details of the Notified Authority to whom application is submitted.

     Designation of Notified Authority...........................................................................................

     Place.....................................................................................................................................

     State of.................................................................................................................................

2.  Details of the applicant:

    (a) Name of the applicant.......................................................................................................

    (b) Name of the concern........................................................................................................

    (c) Postal address with telephone number...............................................................................

3.  Place of business (Please give full address)

    (i) For Sale

    (ii) For Storage

4. Whether the application is for -

        Manufacturer                         Importer                          Pool Handling Agency            

        Wholesale Dealer                   Retail Dealer        

       ( Tick mark whichever is applicable)

5.  Details of fertiliser and their source in Form 'O'**      

   Name of fertiliser

Whether certificate of source in Form 'O' is attached

[Please tick mark whichever is applicable]

6. I have deposited the registration fee of Rs......................................................................................

vide Challan No............................. Dated......................................    .........................................in the

Bank / Treasury ......................................................................................or enclose Demand Draft No.

.......................................... Dated ................................. for Rs. .........................................................

drawn on ............................................. in favour of ...........................................................................

payable  at ................................................................................................... towards registration fees

7. Whether the intimation is for an authorisation letter or a renewal thereof . (Note: In case the intimation is for renewal of authorisation letter, the acknowledgement in Form A2 should be submitted for necessary endorsement thereon.)

8. Any other relevant information.

I have read the terms and conditions of eligibility for submission of Memorandum of Intimation and undertake that the same will be complied by me and in token of the same, I have signed the same and is enclosed herewith.

Date:

Place:

Signature of applicant

Terms and conditions of authorisation:

(1)  I shall comply with the provisions of the Fertiliser  (Control) Order, 1985 and the notifications issued thereunder for the time being in force.

(2) I shall from time to time report to the Notified Authority and inform about change  in the premises of sale depot and godowns attached to sale depot.

(3) I shall also submit in time all returns as may be prescribed by the State Government.

(4) I shall not sell fertilisers for industrial use .

(5) I shall file a separate Memorandum of Intimation for , where the storage point is located outside the area jurisdiction of the Notified Authority where the sale depot is located.

(6) I shall file a separate MOI for each place when the business of selling fertilisers is intended to be carried on at more than one place.

(7) I shall file separate MOI if I carry on the business of fertilisers both as retail and wholesale dealer.

(8) I confirm that my  previous certificate of Registration or Authorisation is not under Suspension or Cancellation or debarred from selling of fertilisers.

DECLARATION

I / We declare that the information given given above is true to the best of my / our knowledge and belief and no part thereof is false or no material information has been concealed.

Date:

Place:

Signature of the Applicant(s)

* Vide S.O. 49(E) dt. 16.01.03

** Attach a separate sheet if the number exceeds three.