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313
 . FORlV(IA"
_ - (Ste Rule ~4)
. (Court fl;!elabel R.s. 'Five tobe affixed) to
-,
"
Forin of ~pp1icaJi()llfor grant of renewal or a license to sell Stamps
.' . - . _ . under the Rajasthan Stamp Act,1998 .

Applicants Name in full ...................................- ~..""" ..~ ", 'I , ~

arid residential' address .......................... " ' ~ ~ ..

" Date of.bit'th

, , .,- •..•.•. 1 ... •.•

. . : ,",

3. Place ofveqd \~,l:¢retho applicant . , .

desires to,vendstan:lips '. . ...........................
i ..~ .

Place ............................ , ~ " ..

Town ......,..·f.· ,., .
Tehsil
District '.' .:: ',I:
.. """ ..". "" ..,," , •• f •• "

."."."" ... ", .. ~"""

It'"" •• " .. " .. f"

.. ..". .,," ..,

" "
":"" ~." ....
:~" ....... " .... '" ~..

,,"'" ,,,. """ .. " " ~,..

."
,,: ',"
.' :;". ','., ,,",'\,' " ,-

4. EQ1Watiq~~ Q~alifip!ition ." .' .'.~•••• "•••• " ~••'!••~;.'"

~',
••'"'' ~.~
~,~";,,,,". '

5 ·Extenl of ainQLJ:Ilt which the '.

applicalioi): in:v~st.U:l.puIchasm,g.
·staiiWs·fro~i11;rea~~:iy.. ". ":.': .. ,'>-·, 1; " "., ~ "" .
. 6. Present OcC:upatio~~)if any. . :. 1~#.. .L ~ ~.; , .
'] . Wlietlier~pp{icati9~waJlt*·:towi)rk .~: ~ ; ~ " ..
as stamp ve~~r mi . _"!
part,
titJ},e basic
'I I;' ,- ..
',~' k I _ ,I '
'. .'
or full thne'.b~'i>is·· '. . ..
·Name' ~d.address or relative, if
i~ny··m:aCtllig·~.i\p'QI;UnientWrlter '., ; , , ~ .
· ~r 'staluj:>: Vend~i;(i~tatil)grelationship)
..,.on t;he;datc· dfgiving the app~ication -
· WheU1erGOJjlvicte4qfany Criminal. ..., ..
Offell~e,·ort9mov~~ :Go\'tlPrivate
.

10
· serviQ~(giv.e;Pai'tiqulars) .~. .' '.

other r~iavai?-tIhf0rmat.ion~·.If any ....................................................

i
I
I

Not.e:- : . ..
'1.' Affix
,. _ 'Il court fee label of Rs Five. l ,1.\ " '. '

2'.· '.'Att~~4ori,g~n~lROpY.ofthetr.easury chal~allin ~upport pfhaving credited

'. tl1e;PfescriQbE' f~e..: .: -
-3,: . '. bl'cqse
_. ofrenewal'pf
'. licence the previous liGence should be enclosed :1i
. '" Wi~l':the'~pplicatioll; .. ,
4. .; ..:Attach true copies of c~rtifi,cates.in &UPport of date of birth and the last •
. .. cxamiriatiQil passed~. .
1 declare. Ulat I have carefully read the IPljasthan stamps +(ule,2004 and tel~mSilIld
conditions ·odi.c~ce in;FjQt;n.B an{il agr~.to abide by thein; .
• ' .- • "', '. .., I,. ~ • ~ • '. ': "..

1)1'ace .; . . ".' ~,~

'.' ..
. :~
·• . " !
•

:Date . ,.:.. ;..~,...~...,

....,,.. Signature .of applicant .~