Processors Licence New or Modify

Details in Respect of the Owner / Each Partner for Partnership

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. APPLICANT DETAILS

Full Address of the Applicant

Address

City

State

District

Pincode

Phone No

Mobile No

Fax No

OWNERSHIP OF THE FIRM

3. Constitution Details

Constitution Type

Note :

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5. PROCESSING DETAILS

	Address in Full of the Location of the Processing Unit
Note : Enter the Main Processing Address as First Entry




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6. STORAGE DETAILS

	Address in Full of the Place of Storage



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OTHER DETAILS

7. Licence Details

Have you been a licenced Dealer or Manufacturer under the Rubber Act.1947 (24 of 1947)

Yes No

The Date from which you are Processing Rubber

Dealing Date

8. Are you doing or Proposing to do any Business other than Processing Rubber

Give Details

9. Invested Capital or Financial Standing of the Firm

Invested Capital

10. What is the Proposed Capacity or Installed Capacity of the Processing Unit in Kgs

Capacity per day

No of Days Basis

Proposed Quantity

11. What is the Source of Supply of Raw Materials

Source of Supply of Raw Materials

12. State Whether you are Proposing to import the Machinery or Fabricate the same indigenously

Machinery Details

13. What Arrangements have you made for the Necessary Technical Know How

Technical Arrangement

14. What arrangements have you made for Technical Specification as per Standards of the Bureau of Indian Standards

BIS Arrangement

15. What was the Total Quantity of Rubber Acquired, Processed and Sold by you during the Previous Five Years ?

S.No	Year	Rubber Acquired in Kgs.	Rubber Processed in Kgs.	Rubber Sold in Kgs.
1

2

3

4

5

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

Validity Details

Valid From Date

Valid 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 of Incorporation & Memorandum and Articles of Association of the Company / Bye-law of the Society

(iv).

Project Report in respect of the processing unit

(v).

Documentary evidence as to the source of finance

(vi).

Consent Letter issued by the State Pollution Control Board

	Place	:
	Date	:

CREATION DETAILS

Creation Date

Remarks