SCHEDULE-II

Form ‘A’

SEE CLAUSE4 (1)

THE TRIPURA FOODSTUFFS DEALERS LICENCING ORDER 1958

Application For Grant / Renewal of License.

1. Application name :

2. Applicant’s profession :

3. Applicant’s Residence :

4. Situation of applicant’s place or

    places of business with particulars to

    number of house. Mahalla Town or

    village P.S. and District :

5. How long the applicant been

    trading in Food-Stuff :

6. How long the applicant hold a Food

    stuffs license on any previous occasion

    (if so give previous including its

    Suspension or cancellation if any) :

7. Quantity or each Food-Stuff handled 

    annually during the three years :   

       Pulses -

       M oil -

       Salt -

8. Quantity of each Foodstuff likely to be

    handled during the current years : 

       Pulses -

       M oil -

       Salt -

9. Income tax paid in two years

    preceding two years of application For the year     19               19

    (to be indicated separately :                                 19               19

10. a) Quantity of Food Stuff in the 

          possession of applicant on the date of  

          application :

       Pulses -

       M oil -

       Salt -

      c) Complete address of the place 

          where the food-stuffs are proposed

          to be stored :

I declare that quantities of food –stuffs specified above are in my possession this day and are hold at the places noted above (a) I have carefully read the conditions of License given in form ‘B’ appended to Tripura Food-Stuff, Dealer’s Licensing order 1964.

1. I have not previously applied to this District for Foodstuffs license and was/was not granted licenses on.
2. I applied for such license in the District for Foodstuffs license bearing No……………………… Date ……………………. which was granted to me on ………………………
3. I hereby apply for renewal of license No……………………………………….

Dt- …………………… for the ……………… or applied for grant.

Dated ………………….                             Signature of the applicant