Schedule- 13(56)
(Relating to Rule 27)
License to open shop or carry on wholesale business
Serial No.: Ref. No. and Dispatch No:
1. Name of shop or firm:
2. Address:
3. Name, surname of partner of shop/firm or person taking responsibility for
action:
4. Father’s name:
5. Grand-father’s name:
6. Birth place:
7. Permanent address (including Ward No.):
8. Temporary address (including Ward No.):
9. Name of food intended to be sold or distributed or of which wholesale
business is intended to be carried on:
10. Signature:
11. Thumb impressions (only when one cannot sign) 57 : Right Left
12. Photograph:
Signature of the licensing authority:
Name of Municipality or Village
Development Committee:
District:
Zone:
Signature and office seal falling also over the photograph.
License fee: Rs.