Check List - DOCUMENTS REQUIRED FOR AUTHORIZATION LETTER (DRC)

WHOLESALERS/ RETAILERS:
1. The applicant should possess the qualification: Bachelor in Science in Agriculture/In
chemistry/Diploma in Agriculture Science from recognized University/Institute/certificate
course on Agri input for minimum 6 months from MANAGE/NIPHM Hyderabad/and
other Govt. Approved Institute.
2. Application form In Form A1 (in duplicate) duly filled by authorized officer with stamp seal.
3. Power of attorney to sign and submit the documents.
a) In case of Ltd /Pvt. Ltd. Company one of the Director (by Resolution)
b) In case of partnership - one of the partner (nominated by all partners)
c) In case of proprietor ship - proprietor himself.
4. Status of the company / firm.
a) In case of Limited/Pvt. Ltd Company MOA &A (signed copy of Company Registrar)
b) In case of partnership - Attested copy of Partnership deed.
c) In case of proprietorship - Affidavit regarding sole proprietor.
5. List of present Directors of limited/Pvt. Ltd. Company (Name & office & residential address).
6. General affidavit by competent person authorized by resolution of the firm
(BOD)/ MD/Director/partners/ Proprietor himself.
7. Affidavit of responsible person in clause, 24 of FCO,1985(amended uptodate) (nominated by
power of attorney/resolution/partners/prop/himself) appointment letter/joining the company.
a) In case of Ltd./Pvt. Company - Person not below the rank of Manager Marketing/ Sales
Production/ quality control
b) In case of partnership- one of the partner.
c) In case of proprietorship - Proprietor himself.
8. Map of factory/dealer godown verified by concerned Fertilizer Inspector/District Agriculture
Officer of Department and for other States by competent Agriculture Department authority.
9. Attested copy of RC (manufacturing/sale) issued by Director of Agriculture/competent
Authority of state concerned.
10. List of lab. Equipments under clause 21A, FCO 1985, duly verified by concerned DDA of the
district/concerned State).
11. Qualification proof of Lab. Chemist (attested copy)/appointment of chemist (affidavits).
12. Photograph and residential proof of the applicant and person responsible under clause 24, FCO
1985 (amended up to date)
13. Registration Fees Rs.2250/-(Whole sale)/Rs. 500/- for Retail sale to be deposited through
Treasury Challan duly approved by DDO/Authorized officer/e-Challan.
14. Source on Form ‘O’ duplicate duly filled/signed/seal Authorized person of Company.
15. SSI/DIC certificate of the industry department as unit.
16. Quality report of the fertilizers manufactured/sold for the last 3 years.
17. MRP’s of each products with packing sizes
18. Sale business in the State is through 'Company ' office Godown or through appointed
Dealers/agencies-List and undertaking thereof /verification of Godown by concerned
Fertilizer Inspector/SMS (Agr) Block /DDA District.
Imported/100%Water Soluble complex fertilizers: 1. Source of Origin [Link] of Lading.
3. Proforma Invoice [Link] Report of Port from GOI/CFTI, Labs) 5 Information under Clause
35(4) FCO, 1985
(i) Name of Fertilizer (ii) Date of arrival of consignment
(iii) Name of Country of Import (iv) Name of discharge ports
(v) Name of manufacturer (vi) Other information.
 FORM A1
MEMORANDUM OF INTIMATION
(See clause 8(2)

1. Details of Notified Authority to whom application is submitted.

Designation of Notified Authority: Joint Director of Agriculture, Himachal Pradesh,
Place: Shimla-5
State : Himachal Pradesh.
2. Details of the applicant:
(a) Name of the applicant.

(b) Name of the concern

(c) Postal address with

Telephone number.

3. Place of business (Please give full address)

(i) For Sale

(ii) For Storage.

4. Whether the application is for

Manufacturer  Importer  Pool Handling Agency  Wholesale Dealer 
Retail Dealer. 
(Tick mark whichever is applicable)
5. Details of fertilizer and their source in Form "O" is attached (Yes/No)
[Link]. Name of fertilizer Trade/Brand name Source /Country
of Import
1
2
3
4
5
6
7
8
9
 10

6. I have deposited the registration fee Rs. _________________ vide Challan No.__________
Dated ___________in the Bank/Treasury ____________or enclose Demand Draft
No._______________ dated__________for Rs. ______________drawn on________in favour
of _________________________________________________ payable at
______________towards registration fees.
7. Whether the intimation is for an authorization letter or on a renewal thereof. (Note: In case
the intimation is for renewal of authorization letter, the acknowledgement in Form A2 should
be submitted for necessary endorsement thereon)
8. Any other relevant information.

I have read the terms and conditions of eligibility for submission of Memorandum of
Intimation and undertake that the same will be complied by me and in token of the same, I
have signed the same and is enclosed herewith.

Date: ________
Place:________

Signature of Applicant.
Attach a separate sheet if the number exceeds five.

TERMS AND CONDITIONS OF AUTHORISATION:-

1. I shall comply with the provisions of the Fertilizer (Control) Order, 1985/2008 and the
notifications issued there under for the time being in force.
2. I shall from time to time report to the Notified Authority and inform about change in the
premises of sale depot and godowns attached to sale depot.
3. I shall also submit in time all the returns as may be prescribed by the State Government.
4. I shall, not sell fertilizers for industrial use.
5. I shall file a separate Memorandum of Intimation for, where the storage point is located
outside the area jurisdiction of the Notified Authority where the sale depot is located.
6. I shall file a separate MOI for each place when the business of selling.
7. I shall file separate MOI if I carry on the business of fertilizers both as retail and wholesale
dealer.
8. I confirm that my previous certificate of Registration or Authorization is not under
suspension or cancellation or debarred from selling of fertilizers.
DECLARATION:
I/We declare that the information given above is true to the best of my/our knowledge and
belief and no part thereof is false or no material information has been concealed.

Dated: ________
Place : _________
Signature of the Applicant(s)
(Seal)
 Form “O”
[See Clause 8 and 11]

CERTIFICATE OF SOURCE FOR CARRYING ON THE BUSINESS OF SELLING FERTILIZERS IN THE

WHOLESALE/RETAIL FOR INDUSTRIAL USE

No.________________________________ Date of issue_________________

1 Particulars of the issuing the certificate of source

(a) Name and full address
(b) Status (i) State Government
(ii) Manufacturer
(iii) Pool handling agency
(iv) Wholesale dealer
(v) Importer
(c) If manufacturer of mixture of fertilizers, the details of certificate of manufacturer of
mixture of fertilizers possessed:
(i) Number
(ii) Date of issue
(iii) Date of expiry
(iv) Grades of mixtures of fertilizers allowed to be
manufactured
(v) Authority by whom issued
(d) Details of certificate of registration
(i) Number
(ii) Date of issue
(iii) Date of expiry
(iv) Authority to whom issued
2 Particulars of the person to whom the certificate of source is being issued

(a) Name and full address

(b) Status (i) Wholesale dealer

(ii) Retail dealer
(iii) Industrial dealer
 (c) If holds a valid certificate of registration, the details thereof
(i) Number
(ii) Date of issue
(iii) Date of expiry
(iv) Authority by whom issued
(d) Purpose of obtaining the certificate of source
(i) For obtaining a fresh certificate of registration
(ii) For renewal of the certificate of registration
3. Details of fertilizer(s) to be supplied
[Link]. Name of fertilizers Trade mark/Brand name Source/Country of Origin
1
2
3
5
6
7
8
9
10
4 Declaration: Declared that the fertilizers mentioned above will be supplied confirming to
the standards laid down under the Fertilizer (Control) Order, 1985 and, as the case may
be, grades/formulations (of mixtures of fertilizers) notified by the Central/State
Government and packed and marked in container as provided under Clause,21 of the
Fertilizer(Control) Order, 1985(amended up to date)

Date:
Place:
Signature with stamp of the
Authorized Person with Seal

Proforma
Inspection Report of Fertilizer Inspector (SMS(Agr) Block
 (Premises used for Sale & Storage of Fertilizers)
1. Name & Address of Company
2. Name of Manufacturer/Importer/Dealer
3. Name/ Contact No. of Authorised Person
4. Whether premises used for
a) Address of Sale Point
b) Address of Storage
c)Dimension in Ft (Length * Width)
d) Area in Sq Ft
e) Capacity in MT
f) Layout/Site map of sail point/godowns
5. Premises used for sale/storage of
Fertilizer
6. Enclosed Map/Sale and Storage Point
7. How is the Floor of Storage or Sale Point
8. How is the ventilation of storage/sale
Point
9. How is the Roof of storage/sale point:-
10. Whether electrification is safe for
storage/Sale Point:-
The Documents mentioned in this report are verified by me :-
I/we have physically checked and verified the above mentioned premises on
_____________________ and found that the premise is suitable for storage of fertilizer.

Signature of Authorize Signatory

Q.C. Inspector of the Department Representative of Company/Sale
Name:- Point /with name
Designation:- Signature & seal

Verified/Countersigned by:
DDA:-________________
DAO:-_________________
Department of Agriculture Himachal Pradesh State.
 DEPARTMENT OF AGRICULTURE
HIMACHAL PRADESH
FORM A2
ACKNOWLEDGEMENT
See Clause 8(3)
BOOK No. 2 Registration No.
Date of Issue
Valid up to
Received from a complete "Memorandum
of Intimation" along with Form "O", fee of Rs /- Deposited through Treasury Challan bearing
No. dated in the .

2. This acknowledgement shall deem to be a "letter of authorization" entitling the applicant

to carry on the business of fertilizers in the State of Himachal Pradesh as a retail dealer as applied for,
for a period up to from the date of issue /amendment of this Memo, of
acknowledgement unless suspended or revoked by the competent authority:-
Name of Location of Name/Grades of Fertilizers Brand Name Source
Company/ sale Depot/ go
firm down

Seal:
Notified Authority–Cum-
Assistant Project Officer(Agri)
Date: Spiti Valley at Kaza Himachal Pradesh,