FORM III 1. Name, address and status of the applicant
2. Address of the premises where the manufacturing
activity will be done 3. Name of the insecticide with their registration
number and date for which Name of insecticide / Registration No./ Date
1_________________________________________________________ 4. Whether any registration is provisional, if so,
give particulars 5. Details of full time expert staff connected
with the manufacture and testing of Name / Qualification / Experience
1_________________________________________________________ 6. Whether all the facilities required under
Chapter VIII of the rules have been 7. Particulars of the fee deposited:___________________________________
Signature of the applicant________________ VERIFICATION I ________________S/o___________________do hereby solemnly verify that to the best of my knowledge and belief the information given in the application and the annexures and statements accompanying it, is correct and complete. I further declare that I am making this application in my capacity as___________and that I am competent to make this application and verify it by virtue of ______________ a photo/ attested copy of which is enclosed here with. Date:____________________ Signature with seal._________________
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