I/we hereby apply for renewal of the license to stock and use of restricted insecticide for categories, 1, 2 and 3, under the name and style of ________________________. The license desired to be renewal was granted by the licensing authority and allotted license No.________________ on the day of______________2000____________.
signature of the Applicant___________
I _______________ s/of _______________do hereby solemnly verify that to the best of my knowledge and belief the information given in the application and the annexures and statements accompanying it, is correct and complete.
I further declare that I am making this application in my capacity as (designation) and that I am competent to make this application and verify it by virtue of a photo/ attested copy of which has already been submitted.
Signature with seal________________