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