You are on page 1of 2

স র ব বস র জন সরক র অনমত পত র দরখ স

EMBLEM
FORM 'H'
[See Clause 23(1)(b)]

APPLICATION FOR GRANT OF PERMISSION TO SALE


NON-STANDARD FERTILISERS

To
The Registering Authority
State of ..........................

(1) Full name and address of the applicant .................................................................................


...................................................................................................................................................................

(2) The name of fertilisers in which the applicant has been authorised to carry on business :

(3) Number and date of registration certificate granted in favour of the applicant :

(4) The particulars of non-standard fertilisers which are intended to be sold :

(i) Name of the fertiliser :

(ii) The source from which the fertilisers were originally purchased and the period during
which they have held by the applicant.

(iii) Brief reasons leading to the material having become non-standard.

(iv) The chemical specification as analysed by an authorised chemical laboratory :

(v) Name and appearance of the non-standard fertilisers.

Note : *Chemical analysis to be indicated shall be one which has been certified by a notified
Fertiliser Control Laboratory on the basis of samples drawn by the Fertiliser Inspector.
I enclose a copy of the certificate of registration for dealing in fertilisers already granted to me
and I have deposited the prescribed fee for permission to sell non-standard fertilisers.

I certify, that I will comply with the requirements of sub-clause (a) of clause 23 of the
fertilisers (Control) Order,1985 which requires that each

container of non-standard fertilisers is to be conspicuously superscribed with the words "non-


standard" and also with the sing "x" both in red colour.

Signature of the applicant

Name and address of applicant in block letters ..............................................................................


.....................................................................................................................................................................

Date : ...................................................

Place : .................................................

*Vide S.O. 49(E) dt.16.01.03.

You might also like