area TF Ae: Application Form No. sate et sw aids erat reefer Recent photograph “aay signed aRTaTeT fafaes NATIONAL FERTILIZERS LIMITED aedra Paver arate CENTRAL MARKETING OFFICE ett, dee-24, atest - 201301 (Sm) ‘Att, SECTOR24, NOIDA -201301 (UP) ate fash Stare A Page & Ae anes or APPLICATION FOR APPONTHENT OF WHOLESALE DEALER ah gem foe aoe aia ae a Category Please tick Reserved ‘Specal_| General (qrater gait 8a) (OFFICE USE ONLY) amdgact wt aT aT Name ofthe Applicant Firm ah Category ww State Bar District Ht) cate MandiBtock cafes sore Estimated Annual Offtake ‘tae separ & ata & eer Signate of Dealer Section Offical_ - ona) recone weet fafres NATIONAL FERTILIZERS LIMITED aed aor aration CENTRAL MARKETING OFFICE ett, fez er - 201201 (35) ‘1, SECTORS, NOIDA-201301 UP) sitar Ranh Stare At farghin a Ae nda -0 APPLICATION FOR APPOINTMENT OF WHOLESALE DEALER (psa ara 3 FRTe FART GE / Please read instucton of up) ‘adtetts Sear ar amor Pret Fe arte Rear rar & "Name ofthe Mandi / Block District applied for wha aE Name ofthe Fim 2 Asdress arratert / GT Otice Shop frames Residence vat Adsross ails, aE Block, Teh ‘Bar Dist ws state Raats Peat waa Phone No ‘range st. ile No ‘Sra ag Emails 3a: gear fran em mie aie ware Category + Please tick Reserves Spoil Genera HIRING Reserved TSAR SHY GL afr seaTAS (HAT) _ Schedules Case (SC) Scheduled Tbe (ST fade Spec 2 Rom eh - ate oh dae | Reuin set | after toe yar SNE APE Ce ate A sat me zen aah ans er seh PRUE | ‘Backward Classes ~ Non Creamy ayer! Physialy Handcapped! Women / Unemployed Graduate You [Ex-Sericemen/ Dependent af defense personne kil in acton and war widows, a 8 oh seth eh AfSat & acd eats adh F Other nol governed under sbove Mo categories aI Goneral_ 4s rete _Flm Details - - - ‘aia a eater [eater aro Frais Raa] aged seve ‘Agency Details Proptetorship Parnership | Body Corporate | Coaperaive Socetystiuton wth FEARS Consuional Status 1 (at a & Prenat aa (ick where applicable) aReavarnersvieeeat stares wa 1 1 weet ait & afta a ar 2. 2. Name of proprietor Parters! 3 3 | Directors! Presigent’ and Secretary of Covperative Society az a VAT No. Baa PAN No. ste # ADHAR No. 1 1 | 2. 2. | | 3. 3 | } ‘at Contd.wan 5. RR atv (ander at 6 ee fh) i cational Quaiteation (Cope cf Cert of apport) 6. ag exerarer erat a eater (af) Detls of Existing Business Operations any) » Feu waver at aaa aT sad tan, we) ira ANG at ange Lecaton Year Extabianes Tumove eintac) —-Anvotes Deas a LUcanse No. as ‘sppieable i) ‘wie dew casera A at, at foe at aa ae sdcet A ara (aie, 4) {in fertizers business. Volume of Frzars sol in at yoo (r MT) — arch at a ‘afer | ‘fret a Name ofthe Company Ursa | AP MOP omer. 2 fm ara BT att Bank Account Details » ae aan eran atta oa ara at wet Hae sagen Haz Bank Name Branch with Adress Aecosnt ype Aeount No IFSC, | fata Rawr Financial Detais i) er Arar z. Creat Lit Re ii) ate / fared aa % ypotecaton Pledge it BR 8, eafearmmarterne weet AAR rarer ae 3am ao (zee) ar hr Det of immovable Propery(s)in te name of Propritr/Panres/Corporate/Co-Operatve Soc ee tara aft at sag] Sa / Fea care wr amends | arena apa | aera | faa a ‘Type of immovable | Address! Location ‘efter (@t af) (sara 4) (eater seen art) | Inwhase name Prpery Pit SzeiCoveredAvea | Estimates Vaiie | Encumbereatnenaim: (Saat (Rs.intats) | bored (Provide deli) 98, Was, Semdh at at a has aaa afer AIT SOR Minimum Cemvited mann wee Oaks of NFL Produts during te year eae ait [ad [at | end | sere] Rar] aiqae| ada | eae] Gat [wat | art | ga | Products fort_| way | sine | Say” | fg. | sep. | oct | Now. | bee. | Jon. | Feb._| warn | fut ‘afar (az) | | eo _ ech za) | | | DAP (MT) | | | ‘wast (atzA) sMoP : eee Sta-sdee (Parsee) Bi Fetzer gts) - ‘ata (feaca) Seats (0) | | | aeerge FORA. EA) | Sertonte Sup (7 a | ara sea | Oe: Prosuts | i ‘ft Contd10, get earerarer Ht Pcer Pater owe % Hew much manoy can you invest in tha busine RS, ene 11, Giver / sharers wile Shop /Godown Detals arr stop ‘hem 1 SA Gedown area faarr Particulars wa | ae 7 aa ‘fea co Own, Hires Tota Own Hired Towa FRA Location Wa ST Floor Area I 12. (@) reps A ada ondeat & Retard a ah Detais of Applicant eatves working n NFL - - aa 0a Seat aaah a et wae Name & Desigraon Paco of Peeing elton a | | | (@)antaat & Redan ar vat Pee seer earewree Hehe / a wos g/t Details of Appicant’s relatives having NFL dealership [HAT / PG. a a a ee eau | Name of Fn Pace Relaton* “aime eee Walt ere FEE Far ata RT Tobe spectied as per GOI rue, 13, Far agar et rea eg ARR athe ar see Aeezor omer cer der ae Peet near ee a aicer eRe Par rer & 2 af oi, at eater & | Has the applicant suffered any penaty under the Essential Commodities Act and! or Fertizere Contol Order or any othe law of the County? yes, give deta 44, ar arte Art aM ee Bebe A ele ate ewer BP wl ag Is the applicant associated with a Fartiizr Mixing plantin any Manner? YesiNo 16, Sam sredtateanenfeneh a area & sear Ferhat | Rae ge) eo oe PIR a aT aT | Details of EMD deposited trough RTGSINEFT only. Demand Draft / Cheque shal not be considered. ag Hae | Rie et ] we | IRN Oa sf Bark sn Bach Arent BE ewe oft er EB sew RR ae Reo wR | AR eA A aT AG aT Ne OG aT B, at ese aa Se A ANT TTT TE GT aT DR et | A) aT Rage A Par wat a awa wet wt ga tat G/B | 11 We confem that he parla 38 given above are rue. case any information ls found to be incorrect even at subsequent sige, NFL shall have the ght 1 eject te appleation trminale the desler fortwin. VWe also undertake to abide by the terms and conons of s9poiniment ‘taka WA (eae / artery Peer we fee 3) @ aR atta anew | at ee ‘Signature of he Applicants alongwith Sea ofthe AgencyFiem (PropretonParinerDirecorPresident 8 Secretary ete) Reeawh: wateoree at fd & aia dra at ato te dent ay fC aT | Note: NFL resones the ret to alocate the tarry tothe deal: within dt.