FORM - A

APPLICATION FOR GRANT OF WHOLESALE/RETAIL LICENCE

(For the trade in paddy and rice/wheat and wheat products/pulses/edible oils & edible
seeds/Chillies(Dry)/Jaggery/Tamarind)

1. Applicant’s particulars:

i) Name :

ii) Son of :

iii) Age :

iv) Whether Scheduled Caste or Scheduled Tribe :

2. Residentail Address of applicant

i) Door No. :

ii) Name of street :

iii) Name of Village/Town :

iv) Name of Taluk :

3. Name/Style in which licence is required :

4. Situation of applicant’s place of business :

i) Door No :

ii) Name of street :

iii) Name of Village/Town :

iv) Name of Taluk :

5. If it is a partnership concern, Name of partners:

1. Thiru. son of

2. Thiru. son of

3. Thiru. son of

4. Thiru. son of

5. Thiru. son of

6. Whether the applicant has applied for a

wholesale/Retail Licence :

7. Particulars of essential trade articles in which the applicant wants to trade:

 i) Paddy and Rice :

ii) Wheat and Wheat Products :

iii) Pulses :

iv) Edible Oils & Edible Oil seeds :

v) Chillies (Dry) :

vi) Jaggery :

vii) Tamarind :

8. Did the applicant previously hold a licence of the essential trade articles for which he has now
applied for a licence:

If so, the following details may be furnished:

Name of the Essential Licence Security Deposit

Trade Articles

Amount Challan Treasury in

which remitted
(1) Remitted No.& Date
(5)
(3) (4)

(2)
1.

2.

3.

4.

5.

9. How long has the applicant been trading in

the essential trade articles for which he has
now applied for a licence? :

10. Availability of finance for carrying on the

trade :

11. Stocks of essential trade articles in

possession on the date of application :

12. Particulars of the place where the essential

trade articles for which licence has been
applied for are proposed to be stores (with
 door No. and street name) :

(i) Whether the storage place is

owned or hired or on lease :

(ii) If on rent, period for which the

lease is valid :

(iii) If on rent, period for which it has

been taken on rent :

13. Has the applicant ever been convicted by

a court of law for contravention of the
provisions of the Essential Commodities
Act, 1955 or any other orders issued
there under? :

14. In the case of applicants who has previously

held a licence the particulars of suspension,
or cancellation of the licence if any :

15. Whether the applicant was declared or

adjudged as an insolvent by a Court of Law :

I declare that the particulars mentioned at items 1 to 15 above are true to the best of my
knowledge and belief and nothing has been concealed therein.

I have carefully read the provisions of the Tamil Nadu Essential Trade Articles (Regulation of
Trade) Order 1984 and the terms and conditions of licence given in form C appended to the
said order and I agree to abide by them.

Place: Signature of the applicant.

Date: