FORM “O’’

[See Clause 8 and 11]

Certificate of source for carrying on the business of selling fertilizers in Wholesale/Retail in MP
No. CAMCO/MPR/MKTG/2021-26/811 Date of issue : 18-03-2024
1. PARTICULARS OF THE CONCERN ISSUING THE CERTIFICATE OF SOURCE
(a) Name and full address : CHAMBAL AGRICULTURE MARKETING COOPERATIVE LTD
525, RAJPUT NAGAR, BHAROULI ROAD, BHIND, (M.P.)
9826260123, 9425133628, 9424853300, 7770868576
(b) Status : WHOLESALE DEALER
(c) Details of certificate of registration
(i) Number : 272/MICRO/21
(ii) Date of issue : 13.07.2021
(iii) Date of expiry : 12.07.2026
(iv) Authority by whom issued : JOINT DIRECTOR AGRICULTURE (FERT.), BHOPAL (M.P.)
2. PARTICULARS OF THE PERSON TO WHOM THE CERTIFICATE OF SOURCE IS BEING ISSUED
(a) Name and full address : M/S ANNAPURNA KRISHI SEWA KENDRA ; PROP. ADITI RATHOR
MAIN ROAD, GALLA MANDI, SEHORE
(b) Status : RETAIL DEALER
(c) If holds a valid certificate of registration, the details thereof ;
(i) Number : 1195
(ii) Date of issue : 28-01-2021
(iii) Date of expiry : 27-01-2026
(iv) Authority by whom issued : DDA SEHORE
3. PURPOSE OF OBTAINING THE CERTIFICATE OF SOURCE
(a) For obtaining a Fresh Certificate of Registration --
(b) For Renewal of Certificate of Registration --
4. DETAILS OF FERTILIZER(S) TO BE SUPPLIED
S.No Name of fertilizers Trade Mark/Brand Name Providers Name
IFFCO UREA; IFFCO UREA (NEEM COATED); IMPORTED UREA (NEEM COATED); UREA
OMIFCO/ UREA IMPORTED; UREA PHOSPHATE 17:44:0 (100% WATER SOLUBLE);
IFFCO NANO UREA (LIQUID); DAP 18:46:00; DAP 18:46:00:0.3 (BORON); IMPORTED
DAP 18:46:00; NPK COMPLEX 12:32:16; NPK COMPLEX 12:32:16:0.3 (BORON); NPK
COMPLEX 12:32:16:0.5 (ZINC); IMPORTED NPK COMPLEX 12:32:16 ; NPK COMPLEX
10:26:26; NPK COMPLEX 10:26:26:0.3 (BORON); NPK COMPLEX 10:26:26:0.5 (ZINC);
IMPORTED NPK COMPLEX 10:26:26; NPKS COMPLEX 20:20:0:13; IMPORTED NPK
MIXTURE 18:18:18 (100% WATER SOLUBLE); IMPORTED NPK MIXTURE 19:19:19
1
(100% WATER SOLUBLE); IMPORTED POTASSIUM SULPHATE (SOP) 00:00:50; IFFCO BRAND IFFCO
CALCIUM NITRATE (N 15.5% & Ca 18.5%) (100% WATER SOLUBLE); IMPORTED
POTASSIUM NITRATE 13:0:45 (100% WATER SOLUBLE); IMPORTED (MAP) MONO
AMMONIUM PHOSPHATE 12:61:0 (100% WATER SOLUBLE); IMPORTED (MKP)
MONO POTASSIUM PHOSPHATE 0:52:34 (100% WATER SOLUBLE); IMPORTED
BENTONITE SULPHUR 90% (GRANULAR); ZINC SULPHATE MONOHYDRATE, 33% Zn;
ZINC SULPHATE MONOHYDRATE, 21% Zn; DI-SODIUM TETRA BORATE PENTA
HYDRATE, 14.5% BORON; DI-SODIUM OCTA BORATE PENTA HYDRATE, 20% BORON;
IMPORTED MAGNESIUM SULPHATE, Mg 9.5%
NEEM COATED UREA 46% (INDIGENOUS); NEEM COATED UREA 46% (IMPORTED);
2 DAP 18:46 (IMPORTED); ZINC SULPHATE MONOHYDRATE, 33%; NPK (12:32:16)
IMPORTED; NPK (10:26:26) IMPORTED; MOP (60%) IMPORTED; IMPORTED NPS KRIBHCO BRAND KRIBHCO
(20:20:0:13)
5. Declaration: Declared that the fertilizers mentioned above will be supplied conforming to the standards laid down
under the Fertilizer (Control)Order, 1985 and, as the case may be, grades/formulations (of mixtures of fertilizers)
notified by the Central/State Government and packed and marked in container as provided under clause 21 of the
Fertilizer (Control) Order, 1985.
For :- CHAMBAL AGRICULTURE MARKETING COOPERATIVE LTD

Authorized Signatory