FORM “O’

CERTIFICATE OF SOURCE FOR CARRYING ON THE BUSINESS OF SELLING FERTILISERS

IN WHOLESALE/RETAIL/FOR INDUSTRIAL USE.

No. FE19-2088861 Date.26.08.2021

1. Particulars of the concern issuing the certificate of source.

(a) Name and full address: M/s. Vijayadurga Phosphate Fertilizers Pvt.Ltd. SHOP NO 1, 2ND
BLOCK, BAGEPALLI MAIN ROAD, CHELURU - 563124, BAGEPALLI TALUK,
CHIKKABALLAPURA DIST, KARNATAKA.

(b) Status: Importer, Wholesale Dealer.

(c) If manufacturer of mixture of fertilisers, the details of certificate of manufacture of mixture of

fertilisers possessed:

1.Number: Not applicable.

2.Date of Issue
3.Date of expiry
4.Grades of mixturers of fertilisers
5.Authority by whom issued

(2) Details of certificate of registration :

1.Number :JDA/F&PP/KAR/FE19-2088861/2021-2022
2.Date of issue : 26-08-2021
3.Date of expiry: 25-08-2026
4.Authority by whom issued :Joint Director of Agriculture, Karnataka.

(d) Particulars of the person to whom the certificate of source is being issued.

1. Name and full address

(b) Status

1. Wholesale dealer :
2. Retail dealer : Retail Dealer
3.Industrial dealer :
(c) If holds a valid certificate of registration, the details thereof :

1. Number:

2.Date of issue:

3.Date of expiry:

4.Authority by whom issued:

(d) Purpose of obtaining the certificate of source:

1.For obtaining a fresh certificate of registration :

2. For Renewal of the certificate of registration :
3. Details of fertiliser(s) to be supplied :

S. No. Name of fertilisers. Trade Mark / Brand name

1. NPK 19-19-19 (IMPORTED) RNZ, VIJAYA DURGA (19-19-19)

2. NPK 13-00-45 (IMPORTED) RNZ, VIJAYA DURGA (13-00-45)
3. NPK 12-61-00 (IMPORTED) RNZ, VIJAYA DURGA (12-61-00)
4. NPK 00-00-50 (IMPORTED) RNZ, VIJAYA DURGA (00-00-50)
5. NPK 00-52-34 (IMPORTED) RNZ, VIJAYA DURGA (00-52-34)
6. CALCIUM NITRATE (IMPOTRED) VIJAYA DURGA (Calcium Nitrate)
7. BORON 20% (IMPORTED) VIJAYA DURGA (Boron 20)
8. NPK 13-40-13 (IMPORTED) RNZ, VIJAYA DURGA (13-40-13)
9.NPK 20-20-20 (IMPORTED) RNZ (20-20-20)
10.NPK 18-18-18 (IMPORTED) RNZ (18-18-18)
11.NPK 24-24-00 (IMPORTED) RNZ (24-24-00)

Declaration: Declared that the fertilisers mentioned above will be supplied conforming to the
standards laid down under the Fertiliser (Control)Order, 1985 and, as the case may be,
grades/formulations (of mixtures of fertilisers) notified by the Central/State Government and packed
and marked in container as provided under clause 21 of the Fertiliser (Control) Order, 1985.

FOR VIJAYA DURGA PHOSPHATE FERTILIZERS P.LTD

Authorised signature