FORM ‘D’

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Form of Licence

 [ See Rule-6 ]

1.Name of applicant for license  :-

( in full)

 2.Full Address

 3.Father’s  name in full

( in case of firm,  names and address of partner

and person holding powers of attorney to act on behalf

of the firm).

4.Profession of the licenses

5.Specific place or places of business

6.Specific purpose for which licence is granted

7.Name of the mineral/ore covered under the licence

8.Challan No showing payment of application fee

9.Challan No showing payment of security deposit

10.Name & address of persons/firms from whom the mineral/ores will

be purchased/procured

11.Period for which license is required

12    I f   it is a  case of renewal the number and date of  grant of original  license

13    No. and date of application for this licence

            Date of grant                                          Signature of the Competent Authority

                                                                           To grant licences with designation

                                                                                                And address

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