1. I/We _____________________of
2. The other details *regarding the manufacture of the
insecticide continue to
3. Particulars of the fee deposited _________________________________
4. The licence is enclosed herewith.
I_________________________S/o ________________________ do hereby solemnly verify that what is stated above is true and correct to the best of my knowledge and belief.
I further declare that I am making this application in my capacity as - _____________________ (designation) and that I am competent to make this application and verify it, by virtue of __________________ a photo/ attested copy of which is enclosed.
Signature with seal__________________
*if there is any change in the details in manufacture or conditions of licence subject to which the licence is required to be renewed, the same may be indicated here.