Recent photo of Recent photo of

the Licensor(s) the Licensee(s)

BIO – DATA
FOR POLICE DEPARTMENT

1 Name (s) of the Licensor(s) with

address and contact number

2 Name(s) of the Licensee(s) with

contact number

Address of the premises to be

3 given on the basis of Leave &
License

Native place / Permanent

4 address of the Licensee(s)

Present address of the

5 Licensee(s)

Nature of work of the

6 Licensee(s)

Reference of two (2) Persons

7 known to the Licensee(s),their
name(s) & Telephone / Mobile
numbers
Family members of the
8 Licensee(s)

Agreement period
9

Name of the Estate agent(s)

10 with address & Telephone /
Mobile number(s)

Identity proof of the Licensee(s)

11

Whatever stated by Me / Us herein above is absolutely true and correct to the best of My / Our knowledge, and if
proved false I / We shall be held responsible for the same thereof.

_______________________ ____________________________ _________________________

Signature(s) of the Licensor(s) Signature(s) of the Estate Agent(s) Signature(s) of the Licensee(s)