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Documents listed overleaf must be enclosed with this application, if it is for the grant
of a licence in Forms XII, XIII, XIV or in Special From
The replies to be given in this column
- Applicant's name :
________________________
Applicant's calling :
________________________
Applicant's full postal address :
________________________
- Situation of the premises where Petroleum is to be stored :
State :
________________________
District :
________________________
Town :
_________________________
Police station :
_________________________
Nearest Railway Station :
_________________________
- Quantity (in litres) of petroleum proposed to be imported and stored :
- Petroleum Class A
(a) In bulk ____________
(b) Not in bulk ____________
(c) Total
____________
- Petroleum Class B
(a) In bulk ____________
(b) Not in bulk ____________
(c) Total
____________
- Petroleum Class C
(a) In bulk ____________
(b) Not in bulk ____________
(c) Total
____________
Total of all classes of petroleum :
____________
Quantity in litres of petroleum already stored in the premises :
- Petroleum Class A
(a) In bulk ____________
(b) Not in bulk ____________
(c) Total ____________
- Petroleum Class B
(a) In bulk ____________
(b) Not in bulk ____________
(c) Total
____________
- Petroleum Class C
(a) In bulk
____________
(b) Not in bulk ____________
(c) Total
____________
Total of all classes already stored:
____________
Number of licence held for the premises and the full name of the holder of the licence.
I hereby declare that the
statements made above have been checked up by me andare true and 1 undertake to abide by
the terms and conditions of the licence, which will be granted to me.
Date of application _______
___________________________________
Signature and designation of the applicant.
- Where the application is made on behalf of a company, the name and address of the
company and the name of the manager or agent should be given and the application should be
signed by him. Every change in the name of the manager or agent shall beforthwith
intimated to, and his specimen signature filed with, the licensing authority.
- "In bulk" means in tanks or receptacles exceeding 1,000 litres in capacity
"Not in bulk" means in approved containers not exceeding-1,000 litres in
capacity.
Documents required to be submitted with this
application Form A-Licence in Forms XII, XIII, XIV or in special Forms
For copies of specifications and plans approved under sub-rule (5) of rule 131 or
sub-rule (3) of rule 148, as the case may be.(Not required for renewal and transfer or a
licence without Amendment)
Licence together with approved plans and specifications attached thereto.(Not required
for the first grant of a licence)
"No objection Certificate" from the District Authority.(Not required for
renewal, transfer and Amendment of a licence without any change in the site of the
licensed premises)
Requisite amount of fees for the grant, amendment or transfer of a licence paid in the
manner specified in rule13.
A certificate of tank testing if required under rule 12.
A certificate of safety if required under rule 130.
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