Affidavit (For Poison & Chemical/sulphur Licenses) printable pdf download

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be affixed &

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AFFIDAVIT

(for Poison & Chemical/Sulphur Licenses)

(Speciman of affidavit to be submitted by applicant on non-judicial stamp paper of

worth Rs10/- duly attested by Notary Public.)

I,_________________________Son/Daughter of Sh._____________

recently residing at _________________________________________________ do

solemnly affirm and declare as follow: -

1. The I am permanent resident of

I am the Proprietor/Partner/Manager/Director of the firm M/s

dealing

Poison

Chemical/Sulphur

MCD/NDMC/DCV valid up to__________________ and other partners/owners have

consented for obtaining Registration Certificate in my name (Consent of other

partners to be attached in the form of Affidavit). My official address, telephone and E-

mail are as under:-

(i)

Official Address_____________________________________________

(ii)

Telephone No. ______________________________________________

(iii)

E-mail ____________________________________________________

The following Poison & Chemicals/Sulphurs are being dealt by the firm: -

Pot. Cyanide, Methyl alchohol, Rashkapoor, Dalchikna, Kuchla, Mitha Telia,

Sankhia white, Sankhia Red, Sankhia Yellow, Sankhia Brown, Mansil, Dhatura,

Arsenic White, Arsenic Yellow, Arsenic Red, Arsenic Black, Aconik, Nux

Vomica, Mansil, Stranium, Peror Murcury, Para Phenylene, Sod. Cyanide, Cop.

Cyanide, Hyderofloric Acid, Cadmim Salt, Silver Salt Canning, Chromic Acid.

2. I undertake that the above firm dealing in Poison & Chemical/Sulphur is

running as per the norms of Master plan prevailing at that time. I also

undertake that it will not violate the provision of MPD-2021. Status of

premises whether owned/rented (Documents in support of property is to be

attached as proof)

3. That I/My Company have no criminal proceedings/case instituted against

me/it in India or abroad till date and I/my company fall in the category of

“suitable person/company” as defined in the “Delhi Poison Rules, 1973”.

4. That I have never been externed from my place of stay by any judicial

authority and neither am I am a proclaimed offender of any state Govt. or of

Delhi Police and to the best of knowledge there is no Red Corner Notice or

any another Look Out Notice pending against me. (Applicable only in cases of

proprietorship concern.)

Affidavit (For Poison & Chemical/sulphur Licenses)

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