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आवेदन-पत्र
13.4 (A) उर्वरक मिश्रण विनिर्माण लायसेंस का नवीनीकरण करना

 

13.4 (A) Renewing Fertilizer Mixture Manufacture License

 
1.Udyog Aadhar Number *
2.(a)Name of the applicant *
(b)Applicant Address with pin code *

Max Length 250 characters

(c)Mobile No. *
(d)Email Id *
3.Does the applicant posses the qualification prescribed by the state Government under sub clause (i) of clause 14 of the fertilizer (control) order, 1985? *
4.Is the applicant a new comer? *
5.Situation of the applicant’s premises where physical/granulated mixture will be prepared. *

Max Length 250 characters

6.Full particulars regarding specification of the physical granulated/special mixture of fertilizers for which the certificate is required and the raw material used in making the mixture. *

Max Length 200 characters

7.Full particulars of any other certificate of manufacturer, if any issued by any other Registering Authority.

Max Length 200 characters

8.How long has the applicant been carrying on the business of preparing physical/granulated/special mixture of fertilizers mixture of micronutrient fertilisers ?

Max Length 250 characters

9.Quantity of each physical/Granulated special mixture of fertilizers/ mixture/of micro nutrient fertilisers(in Tones) in my/our possession on of date of the application and held at different addresses noted against

Max Length 250 characters

10.(I) If the applicant has been carrying on business of preparing physical/granulated/special mixtures/ of fertilizers//mixture of micronutrient fertilizers/give all particulars of such mixtures handled

Max Length 250 characters

  (a).Period of which mixing of fertilizers was done

Max Length 200 characters

  (b).Place(s) of which the mixing of fertilizers was done

Max Length 200 characters

(II) Also give the quantities of physical/granulated/special mixture/ of fertilizer handled during past calendar year
11.In case of special mixture of fertilisers Name and Address of the person requiring the special mixture of fertilisers *

Max Length 200 characters

12.Details of existing Licence
(i) Fertilizer Registration No
*
(ii) Date of Issue (DD/MM/YYYY)
*
(iii) Valid Upto (DD/MM/YYYY)
*
13. Fertilizer Details
अध्यतन करने हेतु विकल्प हटाने हेतु विकल्प सं. क्र. Full particulars of the granulated / physical mixture of fertiliser / organic fertiliser/ biofertiliser / mixture of micro nutrient fertiliser Full address of the premises where the mixture of fertiliser or mixture of micro nutrient fertiliser / organic fertiliser/ biofertiliser will be made
Full particulars of the granulated / physical mixture of fertiliser / organic fertiliser/ biofertiliser / mixture of micro nutrient fertiliser *
Full address of the premises where the mixture of fertiliser or mixture of micro nutrient fertiliser / organic fertiliser/ biofertiliser will be made *
14.M/s/Firm Name *

Max Length 200 characters

15.If the application is for renewal,indicate briefly why the original certificate could not be acted on within the period of its validity *

Max Length 250 characters

16. मैं अपने प्रमाण-पत्र को अपने डिजिटल लॉकर में रखने की सहमति प्रदान करता हूँ। (असहमति के लिये अनटिक करें)
(यह सहमति/असहमति आवेदक से पूछ कर आवश्यक रूप से अपडेट की जाय)

 

DECLARATION

 

(a)I have Deposited the prescribed registration certificate fee/renewal fee
(b)I/We declare that the information given above is true and correct to the best of my/our knowledge and belief, and no part there is false.
(c)I/We have carefully read the terms and conditions of certificate of manufacture given in form F appended to the fertilizer (control) order, 1985 and agree to abide by them.
(d)I/We declare that the physical/granulated mixture/organic fertilizer/bio fertilizer for which certificate of manufacture is applied for shall be prepared by me/us State Government from time to time or by any other person under my/our direction, supervision and, control or under the direction supervision and control of person having the said qualifications.
(e)I/We declare that the requisite laboratory facility specified by the controller, under this order is possessed by me/us.
(f)In case of special mixture of fertilisers ;
    I am enclosing an attested copy of the requisition made by the purchaser of the special mixture of fertilisers

 
आवश्यक दस्तावेज (आवेदक द्वारा स्वप्रमाणित) :

दिनांक :
स्थान :

(हस्ताक्षर)

आवेदक का नाम



Source: http://mpedistrict.gov.in Friday, May 10, 2024 7:05 AM







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