Fertilizer License Request

Weather the application is for * Manufacturer Retail Dealer Wholesaler Dealer

Permanent Address *

State*

District *

Tehsil

State *

District *

Tehsil

Mobile No. *

Landline no

Email *

Address of Storage Place*

Qualification Technical Qualifiation *

S.No.	Degree*	University / Institution *	Duaration (In Months)*	Applicant Name*	Action
1

Details of fertilizer and their source

S.No.	Name of Fertilizer Category*	Name of Fertilizer*	Company Name *	Category of WholeSaler *	Validity Date*	(O Form)*		Action
1	0		1

Details of fertilizer / Mixer

S.No.	Name of Fertilizer Category *	Name of Composition*	Quantity*	Duration(In Months)*	*		Action
1	0			1

Name of Partners

	*	*	*	*	Action
1

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