Dealers Licence new or Modify

1. LICENCE DETAILS

Application No

Application Date

Name of the Applicant

Name of the Unit/Firm/Company

Licence Year

Note : Licence will be issued in this name

Note : Year for which Application is to be considered

2. OFFICE DETAILS

	Address in Full of the Place of Business
Note : Enter the Head Office Address as First Entry




Note : Click the Plus button to add more Rows Unselect the Checkbox to Remove the Unwanted Rows

3. STORAGE DETAILS

	Address in Full of the Place of Storage



Note : Click the Plus button to add more Rows Unselect the Checkbox to Remove the Unwanted Rows

4. OWNERSHIP OF THE FIRM

Constitution Details

Ownership Type


	Details in Respect of the Owner / Each Partner for Partnership

Note :

Click the Plus button to add more Rows
Unselect the Checkbox to Remove the Unwanted Rows

OTHER DETAILS

5. Licence Details

Have you been a Licenced Rubber Dealer under the Rubber Board

Yes No

6. From what Date have you been Dealing in Rubber

Dealing Date

7. Invested Capital or Financial Standing of the Firm

Invested Capital

8. What was the Total Quantity of Rubber Purchased and Sold by you during the Previous Five Years ?

(If accurate figures are not available approximate figures may be given)

Period For which Licence Required

Period From Date

Period Till Date

License Amount Fetch Page

Payment Details


Advance Amount Available

Data Not Available

Type

Amount To Pay

Amount Paid

Bal Amount to Pay

Total

Excess Amount Available :	0.00

Advance Deposit Available :	0.00

List of Documents to be enclosed

(i)

Affidavits

(ii)

Proof of Payment of Fee

(iii)

Partnership Deed / Certificate issued by Registrar of Firms / Memorandum & Articles of Association and Certificate of lncorporation issued by the Registrar of Companies / Copy of the Byelaws

(iv)

Identity Card duly attested

	Place	:
	Date	:

CREATION DETAILS

Creation Date

Remarks