FORM - D
Application for issue of Special Licence to Purchase or Otherwise Acquire Rubber
(Page 1 of 5)
 1.  LICENCE DETAILS
  Application Number   Date of Entry Click Here to Pick up the date
  Name of the Applicant   Name of the Unit/Firm/Company
  Licence Year   Note : Licence will be issued in this name
 2.  PARTICULARS OF REQUIREMENT OF RUBBER AND DETAILS THEREOF:
Quantity of rubber applied for and the period for which it is required (show dry rubber weight in the case of latex)
Select
Sr.No Grade
  Total Tonnage :
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Actual Consumption during the previous year
      Total Tonnage : 0
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Stock of rubber held on the date of application or purchased and in transit or awaiting delivery
      Total Tonnage : 0
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Application for issue of Special Licence to Purchase or Otherwise Acquire Rubber
(Page 2 of 5)
 3.  GENERAL PARTICULARS
Click Here To Add New Office Details Office Address
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Click Here To Add New Factory Details Factory Address
Note : Enter the Main Factory Address as First Entry
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Click Here To Add New Storage/Depot Details Storage/Depot Address
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Application for issue of Special Licence to Purchase or Otherwise Acquire Rubber
(Page 3 of 5)
 4.  OTHER PARTICULARS
Udyog Aadhar No. GST Registration No. Permanent Account Number (PAN) Local Authority (Punchayat/Municipality/Corporation)
Licence Certificate Number and Date of Registration :
Upload File:
  Electricity Connection Status Connected Applied For Not-Reqd Generator-Support
 
 5.  NAME OF THE BANKERS AND BRANCH,IF ANY
  Banker Availability Status    Yes No
 6.  PRODUCTS TO BE MANUFACTURED BY USING NATURAL RUBBER (Select the Items)
  Product Name   Note : Hold ctrl key for Multiple Selection
  Selected Products
 7.   DETAILS OF PRODUCTS MANUFACTURED DURING THE PREVIOUS FINANCIAL YEAR
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  • Installed capacity shall be either in weight or in numbers as the case may be
  • Quantity of rubber used should be given seperately for the each product
Application for issue of Special Licence to Purchase or Otherwise Acquire Rubber
(Page 4 of 5)
 8.  Click Here To Add New Owner Details OWNERSHIP PARTICULARS
 
  Constitution Type  
  If any change has been taken place in the ownership and constitution of the unit within the last one year and if failed to inform such changes to the Board at the appropriate time, furnish the details, thereof : (applicable in the case of renewal)    
Upload File :
 Details in Respect of the Owner / Each Partner for Partnership
  In the case of partnership firm state the date of partnership deed with the details of registration with the registrar of Firms and in the case of companies Memorandum and Articles of Association and Certificate of Incorporation (Furnish the photocopy of partnership deed in the case of partnership firm or Memorandum and Articles of Association and Certificate of Incorporation in the case of Companies or Bye laws in case of Societies,whichever is applicable)    
Upload File :
State whether proprietor or partners or directors of the unit have been at any time a rubber dealer or processors or rubber goods manufacturer or an agent of any other licensed rubber dealer or processors or manufacturer or have been an applicant for rubber dealer's or processor's or manufactuerer's licence. if so, furnish details
 9.   LIST OF MACHINERY INSTALLED
Sl.No Machinery Name Name and Address of Supplier of the machinery Upload Invoice Bill No Date Value(Rs)
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 10.   VALUE OF ALL FIXED ASSETS OF THE APPLICANT AS ON DATE OF APPLICATION
(AS ON 31ST MARCH OF THE PREVIOUS FINANCIAL YEAR, IN THE CASE OF RENEWAL)
(Details of immovable properties and other assets owned by the Properietor or Firm or Company or Society)
Select Sr.No Asset Type Asset Value(Rs) Balance Sheet
      Total Asset Value : 0
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Application for issue of Special Licence to Purchase or Otherwise Acquire Rubber
(Page 5 of 5)
DECLARATION
I / We declare that we have submitted the monthly K&L returns up to the month of
Form - K(For Renewal) Yes No Not Applicable
Form - L(For Renewal) Yes No Not Applicable
I / We declare that the statements made above are true to the best of my/our knowledge and belief.
   
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  
Place :
Date : Click Here to Pick up the date
Creation Details
  Creation Date   Remarks
   
User Creation Details
Login Details
User Type Manufacturer
Application-No (User-ID)
Corporate Name
Contact Person/Name
Address
City
Pincode
State
District
Land Phone
Mobile
Email
Password
Repeat Password
Secret Question  
Secret Answer  
Date Click Here to Pick up the date
Place