Fertilizer License Request

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Fertilizer License

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Weather the application is for * Manufacturer Retail Dealer Wholesaler Dealer

FORM 'D'

(See clause 14(2) and 18(1))

FORM OF APPLICATION TO OBTAIN A CERTIFICATE OF MANUFACTURE OF PHYSICAL/GRANULATED
MIXTURE OF FERTILIZER OR ORGANIC FERTILIZER/BIOFERTILISER

FORM ‘A1’

[ See Clause 8(2) ]

MEMORANDUM OF INTIMATION

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{{translation.RegistrationNo}} *

{{translation.RegistrationDates}} *

{{translation.LicenseRenewedOffline}}* {{translation.Yes}} {{translation.No}}

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{{translation.RegisteringAuthority}}*

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{{translation.FirmName}}*

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Permanent Address *

State*

District *

Tehsil

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{{translation.PlotNo}} *

{{translation.LocalityWN}} *

{{translation.PinCode}} *

{{translation.MobileNo}} *

{{translation.EmailId}} *

{{AddressTypeName1}}*

{{translation.SameAsPermanent}} *

State *

District *

Tehsil

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{{translation.PlotNo}} *

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{{translation.PinCode}} *

Mobile No. *

Landline no

Email *

Address of Storage Place*

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{{translation.Tehsil}}*

{{translation.UrbanRural}}* {{translation.Rural}} {{translation.Urban}}

{{translation.PanchayatSamiti}}*

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{{translation.Village}}*

{{translation.City}}*

{{translation.PlotNo}} *

{{translation.LocalityWN}}*

{{translation.PinCode}}*

Qualification Technical Qualifiation *

S.No.	Degree*	University / Institution *	Duaration (In Months)*	Applicant Name*	Action
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Details of fertilizer and their source

S.No.	Name of Fertilizer Category*	Manufacture Type	Name of Fertilizer*	Company Name *	Wholesaler Name *	Category of WholeSaler *	Validity Date*	Wholesaler Validity Date*	Manufacturer Validity Date*	Area of Opration*	State	District	Tehsil	{{translation.UploadFileText}} (O Form)*	{{translation.View}}	Remarks	Action
{{ $index+1}}	{{item.CompanyDetailsId}}	{{item.CompanyDocument}}	{{ $index+1 }}		Select, If Manufacture in Rajasthan														{{item.DocRemark}}

Details of fertilizer / Mixer

S.No.	Name of Fertilizer Category *	Name of Composition*	Other Category Type	Name of Grade	Composition Details	Notification Date	Notification Document	{{translation.View}}	Quantity*	Duration(In Months)*	{{translation.UploadFileText}}*	{{translation.View}}	Remarks	Action
{{$index+1}}	{{item.CompanyDetailsId}}	{{item.CompanyDocument}}		{{ $index+1 }}			Select,In Case Other Type										{{item.DocRemark}}

Name of Partners

{{translation.SRNO}}	{{translation.PersonName}}*	{{translation.MobileNo}}*	{{translation.EmailId}}*	{{translation.PartnerAddress}}*	Action
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FileType	UploadFile	View	{{translation.Remark}}
{{x.DocumentMasterId}}	{{x.TechnicalQualificationId}}	{{x.DocumentMasterEn}}	{{x.DocumentMasterEn}}			{{x.Remarks}}

{{translation.LicenseFee}} :{{translation.Rs}} {{Fee}}/-

Fertilizer License Request

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