FORM VI-B
[
Rule 10(3 A)]
APPLCATION FOR RENEWAL OF LICENSE TO STOCK AND USE OF RESTRICTED INSECTICIDES FOR COMERCIAL PEST
CONTROL OPERATION(S)

To
The licensing authority,
State __________________

I/we hereby apply for renewal of the license to stock and use of restricted insecticide for categories, 1, 2 and 3, under the name and style of ________________________. The license desired to be renewal was granted by the licensing authority and allotted license No.________________ on the day of______________2000____________.

  1. state of change if any, in:
  1. category of operation
  2. expert staff
  3. restricted insecticides used
  4. premises of stocking
  5. address including of branch offices
  6. whether any new branch/ unit has been opened after grant or renewal of licence.
  7. any other change.
  1. particulars of fee deposited
  2. give latest details of person engaged (attach separate sheet duly authenticated)

signature of the Applicant___________

verification

I _______________ s/of _______________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 (designation) and that I am competent to make this application and verify it by virtue of a photo/ attested copy of which has already been submitted.

Date._________________
Place._________________

Signature with seal________________