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সার ব্যবসার জন্য
সরকারী অনুমতি পত্রের দরখাস্ত
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EMBLEM
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FORM 'O'
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(See Clause 8 and
11)
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CERTIFICATE OF
SOURCE FOR CARRYING ON THE BUSINESS OF SELLING FERTILISERS IN WHOLESALE /
RETAIL / FOR INDUSTRIALS USE
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No................................................
Date of issue..............................................
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1. Particulars of the concern issuing the certificate of
source
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(a) Name and full
address....................................................................................................................
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.......................................................................................................................................................
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(b) Status:
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(i) State Government
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(ii) Manufacturer
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(iii) Pool handling agency
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(iv) Wholesale dealer
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(v) Importer
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(c) If
manufacturer of mixture of fertilisers, the details of certificate of
manufacture of mixture of fertilisers possessed:
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(i) Number
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(ii) Date of issue
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(iii) Date of expiry
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(iv) Grades of mixturers of
fertilisers allowed to be manufactured
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(v) Authority by whom issued
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(d) Details of
certificate of registration:
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(i) Number
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(ii) Date of issue
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(iii) Date of expiry
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(v) Authority by whom issued
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2. Particulars
of the person to whom the certificate of source is being issued
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(a) Name and
full
address...................................................................................................................
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......................................................................................................................................................
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(b) Status:
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(i) Wholesale dealer
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(ii) Retail dealer
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(iii) Industrial dealer
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(c) If holds a
valid certificate of registration the details thereof:
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(i) Number
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(ii) Date of issue
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(iii) Date of expiry
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(v) Authority by whom issued
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(d) Purpose of
obtaining the certificate of source:
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(i) For obtaining a fresh
certificate of registration
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(ii) For renewal of the
certificate of registration
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3. Details of
fertiliser(s) to be supplied:
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Sl.No.
1
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Name of fertilisers
2
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Trade mark / Brand name
3
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1.
2.
3.
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4. Declaration :
Declared that the fertilisers mentioned above will be supplied conforming
to the standards laid down under the Fertiliser (Control) Order,
1985 and, as the case may be, grades / formulations (of mixtures of
fertilisers ) notified by the Central / State government and packed and
marked in container as provided under clause 21 of the Fertiliser
(Control) Order, 1985.
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Signature with stamp
of the Authorised Officer
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