Insecticides Rules, 1971 - Form VI

FORM-VI
[See Rule 10(1)]

APPLICATION FOR THE GRANT OF LICENCE TO SELL, STOCK OR EXHIBIT FOR SALE OR
DISTRIBUTE INSECTICIDES

To
The Licensing authority,
State of _______________

1. Full name and address of the applicant.____________________________
_________________________________________________________.

2. Is the applicant a newcomer(Say "Yes" or " No")___________________

3. If yes, the name of the principals, if any, whom he represent ____________

4. [****]

5. I enclose a certificate from the principals whom I represent or whom I intend
to represent and the source/ sources from which insecticides will be obtained.

4. [****]

7. Situation of the dealer’s premises where the insecticide will be (a) stored; and
(b) sold

8. The names of the insecticides in which the applicant desires to carry on
business.

9. Full particulars of licence issued in his name by other state government, if any,
in their area.

10. I have deposited the licence fee._________________________________

Treasury challan No._____________
Sub-Treasury_____________

11. Declaration :

a. I/we declare that the information given above is true of my /our
knowledge and belief, and no part thereof is false.

b. I/we carefully have read the terms and condition of the licence and agree
to abide by them.

Name and address of the applicant(s) in block letters.
_____________________________________________________

Date:_________________
Place:___________________

Signature of the applicant.___________________

Remarks by the Licencing Authority

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:

3. is the applicant already in business or newcomer:
4. 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)______________________________________

5. 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.____________________________________________

FORM VI-C
[Rule 10 (3A)]

LICENSE TO STOCK AND USE RESTRICTED INSECTICIDE(S) FOR COMMERCIAL PEST CONTROL OPERATIONS

1. ____________________ is hereby licensed to stock restricted insecticides viz., ____________________ on the premises situated at ________________ and carry out commercial pest insecticides act, 1968 and the rules there under.

a _________________________________________________
b__________________________________________________
c__________________________________________________

Date.____________

License No.______________