APPLICATION FOR TEMPORARY CRACKER LICENSE

Applicant Details

Name of the Applicant *

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Fathers Name *

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Photo of Applicant *

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Applicant Address

Address *

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Country *

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State *

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District

Mobile Number *

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Post Office *

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Police Station *

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Postal / Zip Code *

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Details of premises for which temporary License for storage of fireworks is sought

Type of Land *

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Own Land

Govt. Land

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Name of Village/Ward *

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Road/ Street Name *

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Police Station *

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PIN *

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Type of Storage Room *

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Distance from nearest Petrol / Kerosene/ Diesel Depot *

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Distance from Chemical Shops/ Industrial Area: *

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Distance from protected work * Eg: Name of Educational Institution/ Hospitals

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Distance from Electrical Pole / Power Supply *

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Declaration

I hereby declare that the above information/ particulars given by me are correct.