Application for renewal of manufacturing license for Plant Protection Chemicals

Business Details

Unique Business Identification Number (UBIN) *

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License No/Registration No. *

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Dated: *

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Applicant Name: *

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Name of the Enterprise: *

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Address of the Enterprise

Address Line 1 *

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Address Line 2

Address Line 3

Country *

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State *

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District

Postal / Zip Code *

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Mobile Number

E-Mail

The other details regarding the manufacture of the insecticides continue to remain the same

Insecticides Details

Sl. no.

Name of the Insecticides

Particulars of the insecticide

Registration No.

Date

Sl. no.

Name of the Insecticides

Particulars of the insecticide

Registration No.

Date

Expert Details

Sl. No.

Name

Designation

Qualification

Experience

Sl. No.

Name

Designation

Qualification

Experience

Total No. of Pesticides

Challan Details

Challan Amount *

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Challan Number *

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Challan Date *

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Verification

do hereby solemnly verify that what is stated above is true and correct to the best of my knowledge and belief.I further declare that I am making this application in my capacity as (designation) and that I am competent to make this application and verify it,by virtue of .

do hereby solemnly verify that what is stated above is true and correct to the best of my knowledge and belief.

(designation) and that I am competent to make this application and verify it,by virtue of .

I Agree *