Affix Passport

size Photograph of
CEO or the
Designated
FORM - A Officer of your
[See Rule 4(1) and 5(1)] firm

APPLICATION FOR ISSUE / RENEWAL OF LICENCE FOR

AUCTIONEER / DEALER OF CARDAMOM

1. Name of the Person/Firm (in block letters)

2. Address of principal / registered office

Building No.
Building Name

Street
City PIN
State
Tel.
Mobile
Fax
Email
3.
Status Proprietorship Private Limited Company
(Please ? ?where
appropriate) Hindu Joint Family Public Limited Company

Partnership Public Sector (Central Govt.)

Co-operative Society Public Sector (State Govt.)

Others specify

Year of Establishment of the Firm:

?? Strike out whichever is not applicable

4. Type of licence applied for
(Please ? ?where appropriate) E-Auction Dealer
Manual Auction
5. Full name and permanent address of the Proprietor/partners/directors (Attach additional
sheets where required)
Name
Building No.
Building Name
City PIN
State
Tel.
Mobile
Fax
Email

6. Permanent Account No(PAN)

7. DETAILS TO BE FILLED UP ONLY BY APPLICANTS FOR AUCTIONEER LICENCE

(a) Sales Tax Registration

GST
(Attach self attested
copy) Date of issue
Place of issue
CST
Date of issue
Place of Issue
(b) Indicate whether the application is for
renewal of the existing licence or for a new Renewal New
licence (Please ? ?where appropriate)
(c) If for renewal, indicate
Licence No.

Date of Issue
 Place of auction

Day of auction

Time of auction

(d) Answer only if the application is for renewal

Quantity and value of cardamom auctioned during the preceding 3 years
Year Quantity (MT) Value Rs. Lakhs

(e) Indicate Category (Please ? ?where appropriate)

A B C
(A - average turn over above Rs.10 crores B- average turn over Rs. 1- 10 crores, C-
average turnover
less than Rs.1 crore)

(f) Details of fee remitted

Amount Rs.

(g) Mode of payment Cash Demand Draft

(Please ? where
appropriate )
(h) Demand Draft No. Date
Name of the Bank
(i) If for new auctioneer licence, indicate :
(a) Place of auction
(e-auction common
Center)
Day of auction

Time of auction

(b) Place of auction

(manual) [Wherever
common e-auction
centers are there,
manual auction is not
entertained]
Day of auction
 Time of auction
Frequency

Details of facilities available

i) Address of Collection depots :

ii) Address of new collection depots, if any, :

proposed (please use separate sheets for
(i) & (ii), if required

Address of the Major godown :

Total Capacity of Godowns (M.T.) :

Infrastructure available at the proposed place of manual

auction (Please ? ?where appropriate)
Godown Yes No

Capacity of godown (MT)

Auction Hall Yes No

Area of auction hall

Grading facility Yes No

Weighing machine Yes No
Lot sample display board Yes No
Tables/Chairs Yes No
Auction details display board Yes No
Computer facilities Yes No
(k) Working capital available Rs.
(l) Capital Structure
Authorised capital Rs.
Paid up Capital Rs.

8. DETAILS TO BE FILLED UP ONLY BY APPLICANTS FOR DEALER LICENCE

(a) Sales Tax Registration

GST
(Attach self attested
copy) Date of issue
Place of issue
CST
 Date of issue
Place of Issue
(b) Indicate whether the application is for
renewal of the existing licence or for a new Renewal New
licence (Please ? ?where appropriate)
(c) If for renewal, indicate
Licence No.

Date of Issue

(d) Quantity and value of cardamom purchased and sold during the last three years

Year Quantity (MT) Value Rs, Lakhs

(e) Details of fee remitted

Amount Rs.

(f) Mode of payment Cash Demand Draft

(Please ? where
appropriate )
(g) Demand Draft No. Date

Bank

(h) Source of purchase of cardamom (Please ? ?where appropriate)

Auctioneer Grower Dealer

(i) Storage facilities

Address of godown

PIN
(j) Capacity of godown(MT)

DECLARATION

I/We declare that the information given above are true to the best of my/our knowledge
and belief and that I/We shall abide by the Cardamom (Licensing and Marketing) Rules,
1987, and any instructions given by the Board from time to time regarding the conduct
of business.

Place: Signature

Date: Name

Designation
Note:
1. Separate application shall be made for each category of business as auctioneer or dealer.
Application not accompanied
 To be filled by the Banker

CONFIDENTIAL

1. Name and address of Bankers :

2. Name of the Firm/Company and :

address

3. Constitution : Individual/Jt. Hindu Family/Public Ltd. Co./

Others/Proprietorship/Partnership/Pvt. Ltd.
Co.

4. Name of Proprietor/Partner/Partners/ :
Directors/Karta & Co. Owners of Joint
Hindu Family

5. Nature of Account : Savings/Current/Others

6. Banking Since : Year : No. of Years :

7. Business/Company established/ :
Incorporated on

8. Other allied activities :

9. Nature of Business Activity :

10. If Limited Company : Authorised Capital Rs. ………………………

Paid Up Capital Rs. ………………………

11. Means of Proprietor/Partners :

12. Name and address of Associated :

Concern of the firm

13. Experience as to their dealings : GOOD/SATISFACTORY/UNSATISFACTORY

PLACE: SEAL SIGNATURE :

DAT E: NAME :
DESIGNATION :

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