TRADE LICENCE APPLICATION FORM

To,

The Chief Executive Officer,

Dimapur Municipal Council,
Dimapur: Nagaland.

Sub:- APPLICATION FOR ISSUE OF NEW TRADE LICENCE.

1. Name of Proprietor:____________________________________________________

(IN BLOCK LETTER)

2. Father’s/Husband’s Name:_ _ _____ __ _____ _ ____________________________

3. Permanent Residential Address:_____________________________________________

a)Village/Area/Ward:__ ________________

b) House No.:____________________________________________

c) Post Office: ____________________________________________

d) Police Station: ____________________________________________

e) District: ____________________________________________

t) State: ____________________________________________

4. Present Postal Address:

a) Village/Area/Ward: ____________________________________________

b) House No.: ____________________________________________

c) Post Office: ____________________________________________

d) Police Station: ____________________________________________

e) District: ____________________________________________

i) State: ____________________________________________

g) Telephone/mobile No/. : ____________________________________________

h) E-Mail Address: ____________________________________________

6. Nature of Business: ____________________________________________

7. Particulars of Partners if any:

I. a) Name: ____________________________________________

b) Father’s Name: ____________________________________________

c) Address: ____________________________________________

II. a) Name :

b) Father’s Name:

c) Address:

8. Location of Business:

9. Ward No. :

l0. Patta No. _______________ Dag No. _____________ Block No. _____________________

(Signature of Applicant)

N.B.:- Details to be furnished:

a) Documents in support of Permanent Residency certificate (PRC) of the

applicants compulsory (Non Locals).
b) The details furnished in Sl.No.l0 should reflect whether it is in own building
c) “No OBJECTION CERTIFICATE" from the House Owner should be furnished, if` the
building is rented.

FOR OFFICE USE ONLY

Sl.No._____________ R/Book No.______________ Receipt No.__________________

Date of issue:_______________ Initial: _________________________