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PUNJAB GOVT. Gf\.Z. (EXTRA),AUGUST21, 2013 1039

(SRV1~ 30,1935 SAKA)
FORM-I
[See rule 3(1)]
APPLICATION FORM FOR GRANT OF LICENSE

Affix passport size

photo of the
applicant

l. Name of the applicant

2. Father's name

( 3. Permanent residential address

4. Temporary residential address;

ifany

5. Police Station concerned

6. Post Office concerned

7. Present financial status

of the applicant (in few words)

8. Passport details of the applicant

C~ (if any)

9. Details of Demand Draft n.D.No. Dated

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Name of the Bank
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10. Has the applicant is ever denied
License under these rules, if so,
give 'detai Is therefor

11. Details of the relatives of the

.
~",

applicant, ifliving abroad with

postal address

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1040 PUNJAB GOVT. GAZ. (EXTRA),AUGUST21, 2013

(SRVN 30, 1935 SAKA)
12. Details of any criminal
proceedings pending against
the applicant, ifany

13. Has the applicant ever been

convicted by any court? If so,
details thereof

Surety of two persons, who shall be income tax assesses, alongwith their PAN Card
Number and their complete residential address, namely:-
I.

2.

List of documents attached as per sob-rule (2) of rule 3, namely:-

1. .....
~
.2. ~
3.
4.
S.
6.
7.
8.
9.
10.

Signature of the applicant

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