FORM VI-A
[Rule 10(3A)]
APPLICATION FOR THE GRANT OF LICENCE TO STOCK AND USE RESTRICTED INSECTICIDE(S) FOR COMMERCIAL PEST CONTROL OPERATION(S)

To
The licensing authority,
_____________________

  1. Full name of the applicant (block letters)______________________________
  2. Address: _____________________________________________________
  1. registered office_________________________________________________
  2. zonal office____________________________________________________
  3. premises for which applications is made_______________________________
  1. is the applicant already in business or newcomer________________________
  2. qualification of responsible technical person.___________________________
  1. educational qualification__________________________________________
  2. training in pest control operations
  3. experience in using restricted insecticide (s) (Attach proof in respect of claims)______________________________________________________
  1. if in the trade, give full particulars of the names of restricted insecticide(s) handled and categories of operation undertaken, the periods and the place(s) at which the trade was carried on.____________________________________________
  2. Quantity(s) of each restricted insecticide in possession on the date of application (give details of places where it is stored)______________________________
  3. Details of person engaged or proposed to be engaged (attach separate sheet, duly authenticated)______________________________________________
  4. Details of safety application available to along with antidotes and all other facilities required under chapter will be stored for use.__________________________
  5. Situation of the branch office and depots where the restricted insecticide(s) will be stored for use._____________________________________________
  6. Name(s) of restricted insecticide(s) which the applicant describe to use.________________________________________________________
  7. Category(s) applied for._________________________________________
  8. Particulars of the fee(s) deposited.__________________________________
  9. Whether technical expertise _______________________________________