Application for renewal of LPG Distribtor Retail License

To
The Licensing Authority

Sir,

I, hereby apply for renewal of my license no. issued under the Assam Trade Article (Licensing & Control) Order, 1982.

The required particulars are given here under:-

Date on which the licence expire

Name in which licence stands *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

For how many years the renewal is desired

Details of the action, if any taken against the last three years for contravention of an order issued under Essential Commodities Act 1955

Particulars of trade articles in which the applicant wants to carry on business as a

Slno

As a wholesaler

As a Importer

As a Retailer

Slno

As a wholesaler

As a Importer

As a Retailer

Complete address (with House no. market etc.) of godowns or place where trade articles for which licence has been applied will be stored

Village/ Town :

P.S :

District :

Pincode :

I, hereby declare that the particulars mentioned are correct to the best of my knowledge and nothing has been cancelled there in.