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    FP SHOP RENEWAL Application Form

    Uploaded by

    Prabhakararao Valluru
    This document is an application for authorization to run a fair price shop. It requests details about the shop location and dealer applying. It asks for the dealer's name, address, age, education level, family business connections, and any criminal history. It also requests when and where the dealer wants to run the shop, if they can fund it themselves, and confirms they will abide by conditions. Required enclosures include the application form, authorization letter, license, and medical certificate if applicable.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    FP SHOP RENEWAL Application Form

    Uploaded by

    Prabhakararao Valluru
    110 views1 page
    This document is an application for authorization to run a fair price shop. It requests details about the shop location and dealer applying. It asks for the dealer's name, address, age, education level, family business connections, and any criminal history. It also requests when and where the dealer wants to run the shop, if they can fund it themselves, and confirms they will abide by conditions. Required enclosures include the application form, authorization letter, license, and medical certificate if applicable.

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    This document is an application for authorization to run a fair price shop. It requests details about the shop location and dealer applying. It asks for the dealer's name, address, age, education level, family business connections, and any criminal history. It also requests when and where the dealer wants to run the shop, if they can fund it themselves, and confirms they will abide by conditions. Required enclosures include the application form, authorization letter, license, and medical certificate if applicable.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    110 views1 page

    FP SHOP RENEWAL Application Form

    Uploaded by

    Prabhakararao Valluru
    This document is an application for authorization to run a fair price shop. It requests details about the shop location and dealer applying. It asks for the dealer's name, address, age, education level, family business connections, and any criminal history. It also requests when and where the dealer wants to run the shop, if they can fund it themselves, and confirms they will abide by conditions. Required enclosures include the application form, authorization letter, license, and medical certificate if applicable.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    APPLICATION FOR ISSUE OF AUTHORISATION TO RUN A FAIR PRICE SHOP

    FP Shop Details:

    Shop District: __________________________________


    ______________ FP Shop Mandal: _________________________________________
    __________________
    FP Shop Dealer ID: ___________________________
    ________________ Authorization No: __________________________________________
    ____________________________
    FP shop Address: ______________________________________________________________________
    _________________________________________________________________________________________
    ___________________

    FP Shop Dealer Details:

    Dealer Name (In Capital Letters): ________


    ________________________________________________________________
    ____________________________________________________________________
    Father/Mother Name: __________________
    _______________________________ Age & Date of Birth:: ____________________________________
    _________________________
    Caste: _________________________________________
    _____________________Educational Qualification: ____________________________________
    ___________________

    Address: Door No: _____________ Locality/Landmark: ___________________________ Village: _______________________


    ____________________
    Mandal: ______________________ District: __________________________ Pin cod
    code:
    e: _______________________
    ______
    Mobile Number: _____________
    _______________________ E- Mail ID: ______________________________
    _____________________________________

    Whether he is physically
    ally handicapped (YES/No
    (YES/No) __________________________________________________________
    ______________________________
    Whether the applicant is connected with any other business run either by himself or by any member of his family and if so give
    details____________________________________________________________
    ___________________________________________________________________________
    _______________________________
    Whether any number of the applicant’s family has been issued authorization to fair price shop earlearlier and if so give
    gi the details
    ________________________________________________________________
    _____________________________________________________________________________________
    ________________________________________
    Whether any of his blood relations is working in revenue/CS Dept
    Dept. /CS corp. and if so give details
    _____________________________________
    _________________________________________________________________________________
    ________________________
    Village location, Door number, when the applicant wants to run fair price shop, if he is selected
    _____________________________________________________________________________________
    ________________________________________________________________________________________________________ ___________________
    Whether he can raise the sufficient funds to run fair price shop with his own funds and if so give source or whether he needs
    institutional finance__________________________________________________
    ________________________________________________________________________________________
    ______________________________________
    Whether he was convinced earlier for offence under central order issued by the State/Central under E.C
    Act._________________________________________________________________________________
    _____________________________________________________________________________________________________ ____________________
    Amount, Challan number and date through which ffee for issued authorization `and application renewal has been submitted
    ________________________________________________________________________________________________
    ______________________________________________________________________________________________________
    ______________________________________________________________________________________________

    I have carefully read the conditions and I agree to abide by them.

    (a) I have not previously applied for such authorization in this district.
    (b) I applied such authorization in this district on and was not granted.
    (c) I hereby apply for renewal of authorization ……………………………………………………………
    …………………………………………………………………………
    ………………………………………………
    ………………………………………………………………….wh
    ………………………………………………………………….which is enclosed.
    (Strike of the Clauses not applicable)

    Signature of the Applicant


    Procedure (following to be enclosed
    enclosed):

    1) Application Form* Contact Details:


    2) Copy of Authorization letter* Land Line Number :
    3) Latest renewed food grains and kerosene License* Mobile Number :
    4) PHC Certificate (Certificate is enclosed in case he is physically handicapped). E- Mail ID :

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