APPLICATION FORM FOR ISSUE OF TRADE LICENCE
1. Name of applicant …………………………………………...
2. Father’s/Husband’s name …………………………………………
3. Permanent address Circle……………. PO/PS ………………
…………………………………………...
4. Present address …………………………………………...
…………………………………………...
5. Land allotment order (photo
-copy be attached). …………………………………………...
6. Location of the plot proposed
for business. …………………………………………...
Sector ……………………………………
7. Type of building OBT/MIBT/SPT/Log Type/RCC
8. Total plinth area of building ………………………………… Sq. Mtrs.
8. Total covered area by fencing/
Compound wall. …………………………………………...
9. Whether space for parking and
Storage provide. Yes/No.
11. Details of Shop/Rooms. Indicate on Annexure – I
12 . Whether land revenue paid
upto date photocopy of Try.
Challan be attached. Yes/No.
13. Financial Soundness certificate
and Income certificate. :-
14. APST certificate and No criminal
Certificate. :-
15. In case of rented premises submit
the following details.
i) Lease agreement in original be
Attached.
ii) Name of owner of building (with
documents of land allotment and
electricity bill. :
iii) Permanent address of owner …….. ... ………………Village ………………..
………………………… Circle…………………
………………….PO/PS………..Dist………….
………………………………………………….
16. In case of partnership business furnish :-
the following details.
17. Deed of partnership
i) List of share holders as provided
In the guidelines (indicate on
Annexure-II) :-
18. In case of Pvt. Ltd. Company business
furnish the following details. :-
i) Registration certificate. :-
ii) Memorandum and articles of
Association. :-
iii) List of share holders as provided
in the guidelines.
a) Indicate on Annexure-II (include
all partnership in case partnership
and share holders).
b) In case of companies. :-
19. Have you ever been convicted by any court
Of law for committing unlawful activities ?
i) If yes, give details. :-
UNDERTAKING VERIFICATION
I/we do hereby solemnly affirm that the information above is true and correct to the best of my our knowledge and belief.
I/we do hereby undertake to abide by the terms and conditions of trading licence if issue to us also undertake the same in case expiry of lease without further extension of the lease.
Signature in full of the applicant
PART-II (TO BE FILLED BY RECOMMENDING AUTHORITY).
Trade Licence in respect of Shri./Smti. ………………………………….
……………………………… S/o , D/o, W/o Shri……………………………, Village…….…………………….
Circle……………… , may be granted . I have verified the land /building /financial soundness and found correct as stated.
Signature of Recommending Authority, SDO/EAC/C.O.
A F F I D A V I T
I / Shri./Smti./ Miss. …………………………………
S/o, W/o, D/o, Shri./Smti ………………………………..age about…………………….
Village ……………………. Circle ………………………. District …………………….
Do hereby solemnly declare and affirm as under :-
1. That I intent to run business myself ………………
Of East Siang District on obtaining a trading licence from Deputy Commissioner, East Siang District, Pasighat.
2. That I intent to run business myself and I shall no
make any agreement with a Non-Arunachalee for running business on commission basis without prior written order of the Deputy Commissioner.
3. That I shall be bound to comply with all the terms and
conditions laid down into the trading licence and in case of any violation of any terms and conditions of the trading licence same shall be liable for cancellation.
4. That I am not Govt. servant and none of my family
members are in Govt. service.
5. The content of all the for going paras are true to best
of my knowledge and belief and I put my Signature / Thumb impression on the same on this…………………………………. day of …………………………
D E P O N E N T
Signed and solemnly declare on /oath before me in my Court by Shri./Smti. …………………………………… on this ……………………
……………….. day of ………………………….
The deponent is identified by Shri./Smti. ……………
……………………….. who is known to me.
Judicial Magistrate I st Class
East Siang District,Pasighat.
APPLICATION FOR OBTAINING TRADE LICENSE CERTIFICATE /
RENEWAL OF EXISTING TRADE LICENSE
