SCHEDULE VA

( See rule 12(1) )

FORM LD1

Application for Licence as Dealer Manufacturer of Weights, Measures, Weighing Instruments and Measuring Instruments under the Standards of Weights and Measures ( Enforcement ) Act, 1985.

To

The Controller of Legal Metrology, West Bengal,

45, Ganesh Chandra Avenue, 3^rd floor,

Kolkata - 700 013.

To be filled by the Comments of the Inspecting

applicants. Officer

___________________________________________________________________________________________

(1) (2) (3)

___________________________________________________________________________________________

1. Name of the establishment/shop/person

Seeking the licence :

2. Complete address of the concern

a) Office

b) Godown

c) Showroom

3. Date of establishmentworkshop/factory :

4. Name(s) address(es) of proprietor(s) and/or

partners and managing Director(s) in the

case of Limited Company :

5. Number and date of current Municipal

Trade Licence :

6. Category of articles sold at present :

7. Sales Tax Registration Number :

8. Do you intend to import Weights, etc.

from places outside the State ? If so,

indicate sources of supply ………………

………………………………………….

(Give details of manufacturer's trade

mark/monogram and his licence number).

(i) Weights

(ii) Measures

(iii) Weighing Instruments

(iv) Meauring Instruments with details

in each case

9. Have you ever applied for a dealer's

licence either in this State or elsewhere ?

If so, give details :

( To be certified by the applicant(s) )

Certified that I/We have read the Standards of Weights and Measures (Enforcement) Act, 1985 and the West Bengal Standards of Weights and Measures (Enforcement) Rules, 1990 and agree to abide by the same and also the administrative orders and instructions issued or to be issued thereunder.

I/We agree to deposit the schedule licence fees with Government as soon as required to do so by the Licensing Authority.

All the informationfurnished above is true to the best of my/out knowldege.

Place : Signature and Designation

Date :

( To be filled in by Departmental Officer of the State Government )

Date of receipt of application …………………………

Serial Number of application ………………………….

Date of Inspection ………………………..

Recommendation of Inspecting Officer

Place : Signature and Designation of Inspecting Officer.

Date :

Final Orders of Licensing Authority

Licence granted/refused ……………………………

Licence No. ………………………..

Valid till …………………………… Date ………………………..

Place : Signature of Controller of Legal Metrology,

West Bengal.

Date :