The Appeal under section 15 of the Act shall be made in Form-F to the Appellate Authority.
BY ORDER AND IN THE NAME OF THE GOVERNOR OF KARNATAKA, G.A. ADAGATTI Additional Secretary to Government, Commerce & Industries Department FORM - A [see rule 3(1)] GOVERNMENT OF ARNATAKA Office of the Deputy Commissioner - District APPLICATION FOR GRANT/ RENEWAL OF LICENSE FOR STONE CRUSHER Received at (Place), on (date) and entered in the Register (FORM -A), Vol. No. at Serial No. on page No. .
Signature and Designation of Receiving Officer.
From, To, The Deputy Commissioner, District , Sir, I / We submit an application for grant /renewal of stone Crusher license for a period of 3 years over an extent of acres of land in the area specified in this application A total sum of Rs. being the License Fee calculated at per H.P Power and Rs. being the application fee has been paid to Government vide D.D.
No. dated:
for Rs. respectively.
The required particulars are given below:- 1 Name of the applicant with permanent and correspondence address in full.
2 Is the applicant a Government Company / Firm / Association or Registered Co-operative society.
Memorandum of Association, partnership deed, Registration certificate.
3 a) Names of the Directors/ Members and their Nationality.
b) Nationality of the individual applicant.
4 Place & address of registration of the Company / Firm / Association Registered Co-operative Society.
5 Profession or nature of business of the applicant.
6 Details of the area applied for District Tal uk Villa ge Survey No.
Extent of Applied area 7 Project report with full details.
8 Stone crusher Machinery details.
9 Stone crushing capacity per hour.
10 Required Electricity power in Horse power.
11 For renewal of License copy of the earlier license to be enclosed 12 Financial resources of the applicant; (To be supplemented by documents) 13 Any other particulars which the applicant wishes to furnish.
I / We hereby declare that the particulars furnished above are correct and am / are ready to furnish any other details, plant sketches etc. as may be required by you.
Date :
Place :
Signature of the Applicant.
Note : (1) If the applicant is signed an authorized agent, the power of attorney should be attached.
(2) Delete whichever is not applicable.
FORM-B [see rule 3(2)] Acknowledgement for Receipt of application for grant /Renewal of stone crusher license in Sy No. Village of ……………Taluk of District from Sri/M/s on (date) .
Enclosures are as follows, 1) 2) 3) 4) 5) Place :
Date : Signature of the Competent Authority To FORM –C [see rule 3(2)] License for Stone Crusher License No…………………………………….
The license for the establishment of a Stone crusher in favour of M/s/ Sri/ Smt. in Sy.
No…………of………………..Village…………….Taluk District is accorded for a period of three years from the date of issue . The licensee should strictly adhere to the relevant Act and Rules.
This license is valid up to…………………………..
Licensing Authority To, M/s /Sri/ Smt, FORM –D [see rule 3(2)] Refusal letter for Stone Crusher License The license for the establishment of Stone crusher by M/s/Sri/Smt. in ............................Sy. No............ of………………… Village………………… Taluk ………………. District is rejected for the following reasons.
(1)
(2)
(3) censing Authority To, M/s/ Sri/ Smt.
FORM - E ANNUAL REPORT (see rule 6) District…………………………. Year..................
1 Number of applications received ...............................
2 Number of license sanctioned ................................
3 Number of Applications rejected ................................
4 Number of Applications pending. ................................
5 Amount received towards application fee ................................
6 Amount received toward license Fee. ................................
7 Number of applications received for Victim Relief. ...............................
8 Number of applications considered for Victim Relief. ...............................
9 Number of applications rejected. ................................
10 Total amount sanctioned for Victim Relief. ...............................
11 Amount released from the Victim Relief Fund. ................................
12 Amount paid by the license holders as per section 12(5) of the Act.
..............................
13 Statement of income and expenditure balance sheet as per section 14 of the Act. ................................
Signature of the Licensing Authority FORM - F Application for Appeal (see rule 7 ) 1 Name and Address of Individual / Firm/ Company / Registered Co -Operative Society / Association.
2 Profession or nature of business.
3 Full details of the order of the Competent Authority / Deputy Commissioner which the revision application is made (copy to be enclosed).
4 Stone Crusher forming the subject matter of the revision petition.
5 Details of the area in respect of which the revision application is filed.
District:
Taluk:
Village:
Sy No.
6 Is the application filed within Thirty days of the date order of the Competent Authority / as in Sl. No. 3 above.
7 Ground for revision.
8 If the revision applications is filed by the holder of power of Attorney, please attach the power of Attorney.
Place: Signature of the Date: Applicant/Power of Attorney Holder.