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    LicenceApplicationForm AutoLPG 2017

    Uploaded by

    sajal debnath

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    LicenceApplicationForm AutoLPG 2017

    Uploaded by

    sajal debnath
    2 views1 page

    Original Title

    LicenceApplicationForm_AutoLPG_2017

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    2 views1 page

    LicenceApplicationForm AutoLPG 2017

    Uploaded by

    sajal debnath

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    FORM ‘A1’

    [See Paragraph 4(1)]


    FORM OF APPLICATION FOR GRANT OF RENEWAL OF LICENCE

    I hereby apply for a licence under the West Bengal Auto-LPG (Licensing and
    Control) Order, 2004, and furnish the following particulars in connection
    therewith:

    1. Applicant’s Name :

    2. Applicant’s Father’s/Husband’s Name :


    (in the case of an individual)

    3. Applicant’s Residential Address :

    4. Situation of Applicant’s place of :


    business and dispensing station with
    particulars

    5. Name of the Oil Company/parallel :


    Marketeer from which the applicant will
    get his supply

    6. Particulars of Fire Service/Explosives :


    Licence

    7. Particulars of Current Municipal Trade :


    Licence, if the business is carried on
    within the jurisdiction of a Corporation
    or a Municipality

    I declare that the following quantity of AUTO-LPG is in my possession this day and is
    held at the following place, namely,
    ………………………………………………………………………………………………………………………………………………

    I declare that I am the Proprietor/Manager/Partner/Director/Secretary/Lessee of the


    firm or organisation on behalf of which the application is made.

    Date: .............................. ......................................................................


    (Signature or Left Thumb
    Impression of the Applicant)

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