Form C Clause 11 Application For Renewal Of The Certificate Of Registration Page 2
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2Wholesale (Dealer(s).
3.
I/We enclose a certificate of source from the manufacturer(s), importer(s),
Commodity Board(s), State Government(s) wholesale Dealer(s) whom I/We
represent or intend to represent and from whom fertilizer(s) will be obtained by
me/us.
4.
I have deposited the renewal fee of Rs.________________ vide Challan
No.__________ dated ___________ in treasury/Bank ________ or I enclose the
Demand Draft No._____________dt. ________ for Rs._______________ drawn
on _______ Bank, in favour of _______________ payable at ________ towards
renewal fee (Please strike out whichever not applicable).
Full Name and address
of the applicant(s)
Signature of applicant(s)
(in block letters)
Date :
Place :
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Parent category: Legal