FORM OF APPLICATION FOR VERIFICATION OF TITLES

Assistant Press Register, C.G.O Complex (2nd Floor) MSO Building, DF-Block PO- CC Block, SaltLake, Kolkata-700064

Date:

Through Sub Division Officer, Serampore, Hooghly /Sub Divisional Magistrate

Sub: - Verification of Title

With due respect, I am to state that I propose to publish Newspaper/Periodical toward advertisement for all individuals/Businesses, ads for which I suggest the following line(s). My application may please be forwarded to R.N.I, C.G.O. Complex, M.S.O Building (2 nd Floor), Block-DF, P.O. - CC Block, SaltLake City, Kolkata-700064 to get the title(s) verified under Para 6 of the PRG Act 1967, as amend from time to time, before I am allowed to file the declaration to you starting a Newspaper/Periodical as required by the above noted Act. Details are given below:

1)

Name of the Title

2) 3) 4) 5) 6) 7) 8) 9) 10)

Language(s) Periodicity Name of the Publisher Full Address of the Publisher

: : : :

Name of the Owner(s) & Address(es) : Place of Printing Name of Editor(s) & Address Nationality Place of Publication : : : :

Approve the above proposed title to enable me to file the declaration under press and Registration of Newspaper Book(s) Act. Yours faithfully, Date : Place: (Signature of the Owner and Applicant)

Memo No:

Date:

Copy forwarded to the Registrar of Newspaper of India, Ministry of Information & Broadcasting, Government of India, CGO Complex, M.S.O Building (2nd Floor), Block-DF, P.O. CC Block SaltLake City, Kolkata-700064 for favour of expressing his views. The area of publication within jurisdiction of this office. Date : Place:

__________________________ (Full Signature)