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FORM - AAPPLICATION FOR GRANT OF WHOLESALE/RETAIL LICENCE

(For the trade in paddy and rice/wheat and wheat products/pulses/edible oils & edible seeds/Chillies(Dry)/Jaggery/Tamarind)

1. Applicants particulars:i) Name :

ii) Son of :

iii) Age :

iv) Whether Scheduled Caste or Scheduled Tribe :

2. Residentail Address of applicanti) Door No. :

ii) Name of street :

iii) Name of Village/Town :

iv) Name of Taluk :

3. Name/Style in which licence is required :

4. Situation of applicants place of business :

i) Door No :

ii) Name of street :

iii) Name of Village/Town :

iv) Name of Taluk :

5. If it is a partnership concern, Name of partners:

1. Thiru. son of2. Thiru. son of3. Thiru. son of4. Thiru. son of5. Thiru. son of

6. Whether the applicant has applied for awholesale/Retail Licence :

7. Particulars of essential trade articles in which the applicant wants to trade:

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i) Paddy and Rice :

ii) Wheat and Wheat Products :iii) Pulses :iv) Edible Oils & Edible Oil seeds :v) Chillies (Dry) :vi) Jaggery :vii) Tamarind :

8. Did the applicant previously hold a licence of the essential trade articles for which he has nowapplied for a licence:

If so, the following details may be furnished:

Security DepositName of the EssentialTrade Articles

(1)

Licence

(2)

AmountRemitted(3)

ChallanNo.& Date(4)

Treasury inwhich remitted(5)

1.2.3.4.5.

9. How long has the applicant been trading inthe essential trade articles for which he hasnow applied for a licence? :

10. Availability of finance for carrying on thetrade :

11. Stocks of essential trade articles inpossession on the date of application :

12. Particulars of the place where the essential

trade articles for which licence has been

applied for are proposed to be stores (with

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door No. and street name) :

(i) Whether the storage place isowned or hired or on lease :

(ii) If on rent, period for which thelease is valid :

(iii) If on rent, period for which it hasbeen taken on rent :

13. Has the applicant ever been convicted bya court of law for contravention of theprovisions of the Essential CommoditiesAct, 1955 or any other orders issuedthere under? :

14. In the case of applicants who has previouslyheld a licence the particulars of suspension,

or cancellation of the licence if any :

15. Whether the applicant was declared oradjudged as an insolvent by a Court of Law :

I declare that the particulars mentioned at items 1 to 15 above are true to the best of myknowledge and belief and nothing has been concealed therein.

I have carefully read the provisions of the Tamil Nadu Essential Trade Articles (Regulation ofTrade) Order 1984 and the terms and conditions of licence given in form C appended to thesaid order and I agree to abide by them.

Place: Signature of the applicant.Date: