PRESCRIBED FORMS UNDER FERTILIZERS CONTROL ORDER 1957/1985
FORM A
(See Clause 8)
Form of Application to obtain Dealer’s
(Wholesale or Retail or Industrial)
Certificate of Registration
To
The Registering Authority / Controller,
Delhi
1. Full Name and address of the applicant :
(a) Name of the concern and postal address :
(b) Place of business ( Please give exact address)
(i) for sale
(ii) for Storage.
2. Is it a proprietory / partnership/limited Company / Hindu Undivided family concern ?
Give the name(s) and address(es) of the proprietor partners/manager karta.
3. In what capacity is this application field :
(i) Proprietor
(ii) Partner
(iii) Manager
(iv) Karta
4. Whether the application is for wholesale or retail or industrial dealership ?
5. Have you ever had a fertilizer dealership registration certificate in the past ? If so give the
following details :
(i) Registration Number :
(ii) Place for which granted –
( iii ) Whether wholesale or retail or industrial dealership.
(iv) Date of grant of registration certificate.
(v) Whether the registration certificate is still valid ? If not when expired
(vi) If not when expired
(vii) Reasons for not removal
(viii) If suspended / cancelled and if so when ?
(ix) Quantity of fertilizers handled during last year ?
(x) Names of products handled
(xi) Names of source of supply of fertilizers.
6. Was the applicant ever convicted under the Essential Commodities Act 1955 or any order
issued thereunder, including the fertilizers (Control) order, 1957, during the last three
years proceeding the date of Application, if so give details :
7. Give the details of the fertilizer to be handled :
S. No. Name of Fertilisers Source of supply
8. Please attach certificate (s) of source from the supplier(s) indicated under column 3 of sl.
No. 7
9. I have deposited of the registration fee of Rs…………………….. vide Challan
no…………….. dated …………………. in treasury / Bank ……………… or enclose the
Demand Draft No. ………………. Dated ………………… for Rs………………. Drawn
on ……………… Bank, in favour of ……………. Payable at ………………. Towards
registration fee (Please strike out which ever in not applicable ) .
10. Declaration :
(a) I/We declare that the information given above is true to the best of my/our
knowledge and belief and no part there is of false.
(b) I/We have carefully read the terms and conditions of the Certificate of
Registration given in Form ‘B’ appended to the Fertiliser (Control) Order, 1985
and agree to abide by them.
( C) I/We declare that I/We do not possess a certificate of registration of Industrial
dealer and that I/We shall not sell fertilizers for industrial use (Applicable in case
a person intends to obtain a wholesale dealer or retail dealer certificate of
registration, excepting a state Government, a manufacturer or a pool handling
agency).
(d) I/We declare that I/We do not passes a certificate of registration for wholesale
dealer or retail dealer and that I/We shall not sell fertilizers for agricultural use.
(Applicable in case a person intends to obtain a industrial dealer certificate of
registration, excepting a State Government a manufacturer or a pool handling
agency).
Dated ……………. Signature of the Applicant(s)
Note :
1. Where the business of selling fertilizers is intended to be carried on at more then one
place a separate applications should be made for registration in respect of each such
place.
2. Where a person intends to carry on the business of selling fertilizers both in retail and
wholesale business should be made
3. Where a person represent intends to represent more than one State Government,
Commodity Board manufacturer of Wholesale dealer, separate certificate of source
from each such source should be enclosed.
For use in the office of Registering Authority/Controller.
Date of receipt. Name & Designation of
Office receiving the application
