APPLICATION FOR RENEWAL OF THE LICENCE TO SELL, STOCK OR
EXHIBIT FOR SALE OR DISTRIBUTE INSECTICIDES
I/we hereby apply for renewal of the licence to sell, stock or exhibit for sale or distribute insecticides under the name and style of __________________. The licence desired to be renewed was granted by the licensing authority for state of __________________ and allotted licence No._____________ on the _______________day of ______________20 .
The situation of the applicant's premises where the insecticides are /
(i) I/we hereby declare that the situation of my /our premises where the
(a)_____________________________ (b) ___________________________
premises where insecticides are stored / Premises where insecticides are sold.
(ii) the insecticides in which I/we am/are carrying on business and the
full name and address of the applicant in block letters _________________________________________________________
Signature of applicant(s)______________