FORM-
B
APPLICATION FORM FOR
GRANT OF RENEWAL OF LICENCE
(See
Rule 6 (a)
To
The Licensing Authority,
Municipal Council,
Port Blair.
I/We (Name in Block letter) .
aged
Sex
.. by occupation
R/o .. apply for the grant /renewal of licence under the provision of the PFA Act, 1954(Central Act 37 of 1954) and rules made thereunder, for the manufacture for sale/storage for sale/sell/distribution/exhibition of sale of .
..
..
..
by
wholesale/retail within the limits
of
in
the premises situated/the temporary stall
at
...
at
.
Measuring
. Sq.mtrs situated
at
for a period of
upto
.
My/Our annual turnover is of Rs
.
(Rupees
).
I/We
shall abide by the prevention of food Adulteration Act, 1954 and the rules made
thereunder and carry on the aforesaid trade subject to restrictions and
conditions imposed by the licence granted to me/us.
The
amount of Rs
.. in cash/treasury receipt for the fees for licence
as per schedule is enclosed herewith.
I/we
am /are also enclosing Medical Certificate in Form B of my/our own and
also that of my/our employed employees.
In
my/our absence Shri./Smti
. Age
..
Sex
..
address
. Shall conduct the above said business.
The statement made above are true to the best of my knowledge and belief
and if may is found to be false or not true the license shall be liable to be
cancelled.
In
case of partnership or the limited company or Co-operative Society, and attested
copy of the partnership deed or the article of association of the Registration
Certificate Issue, should be attached herewith.
·
Specify
the District or the state
·
Specify
the article of food.
·
Specify
the local area.
Signature
of applicant.