SCHEDULE V [ (See Rule 12 (2)] FORM-LD-2 (Application Form for renewal of licence as Dealer in Weights, Measures, Weighing Instruments and Measuring Instruments under the Standards of Weights and Measures (Enforcement ) Act, 1985.) 1. Name and complete address of the establishment/shop/person seeking the licence 2. 3. 4. Dealer’s licence number Date of Establishment Name(s) and address of proprietors and / or partners and Managing Directors in the case of Limited Company. 5. 6. 7. 8. Number and date of Current Municipal Trade Licence. Category of articles sold at present. Sales Tax Registration No. Are you intending to import weights, etc., from places outside the state. If so, indicate source of supply from the State / States. (Give details of Manufacturers trade-mark / monogram and his licence No.) To be Certified by the Applicants. Certified that I /We have read the Standards of Weights and Measures (Enforcement) Act ,1985 and the Karnataka Standards of Weights and Measures (Enforcement) Rules, 1988 and agree to abide by the same and also the administrative orders and Instructions issued or to be issued thereunder. I /We have deposited the Scheduled licence fees of Rs …………. (………… …………………) to the Sub Treasury / Bank on ……………….. and the original challan is enclosed. All the information furnished above is true to the best of my / our knowledge.
Place: Date:
Signature & Designation.