(Relating to Sub-rule (1) of Rule 4)
Application to be submitted for license to publish Newspaper

To,
The Local Authority,
………………………..
I/We hereby submit this application setting out the following details for
obtaining the license to publish newspaper attached herewith Two copies of
photograph and stamp of One Rupee.
1. Details of Newspaper:
(a) Name:
(b) Type:
(c) Language:
(d) Size:
(e) Number of Pages:
(f) Number of Copies to be Printed:
(g) Location of Publication:
(h) Day of Publication:
2. Location of Office of Newspaper:
(a) Permanent:
Photo

(b) Temporary:
3. Name and Address of the Editor:
4. Qualification of the Editor:
5. Name and Address of the Printing:
6. Other matters:
Applicant’s:
Signature:
Name:
Address: