Application for licence

(See Section 5) Application for licence under the Orissa Cattle and Poultry Feed (Regulation) Act, 1979 1. Name and address of the applicant 2. Address of the factory 3. Description of the cattle/poultry feed which the applicant wishes to manufacture or process. 4. Plan of the factory and list of equipment 5. Whether any power is used in the manufacture of feed. If so, state the exact horse power of the machine used. 6. Total quantity and value of cattle/poultry feed if any, manufactured during the previous year. 7. I/we hereby undertake to comply with all the provisions of the Orissa Cattle and Poultry Feed (Regulation) Act, 1979 and the rules made thereunder and the conditions of the licence. 8. I/we have forwarded a sum of Rs................... in respect of the licence fee. Signatures of the Applicants