(See rule 4)
1. Name and address of applicanit/s.
2. Name and address of firm including its branches or collaterals and other names (aliases) and addresses during the last 10 years.
3. Names and addresses of’partners, if any, including adult members of the family having an interest. in, or share in, the business.
4. Address of showroom/sale premises.
5. Address of all godowns and repositories including residential premises of the constituents.
6. The period for which the applicant has been in business giving the details of his experience.
7. Where the applicant/firm (including all constituents individually and jointly) was convicted of any offence punishable under the Antiquities (Export Control) Act, 1947, or, in any other case involving theft or smuggling of antiquities. If so, details thereof may be stated.
8. Whether the applicant/firm (including all constituents individual or jointly) is a subject of prosecution/investigation/inquiry regarding the infringement of the Antiquities [Export Control) Act, 1947, or the theft of antiquities or art treasures.
9. Whether all stock up to the date of application has been entered in the applicant’s register.
10. The village, town or city, including District and State, where the applicant intents to carry on the business.
11. Nature, i.e. details of the varieties of antiquities in which the applicant wishes to deal in, such as, stone sculptures, metal works, wood works, coins, paintings, jewellery and the like.
12. Category-wise list of all objects on hand claimed by the applicants to be antiquities including those which have been registered with registering officer.
13. Proof of deposition of licence fee, i.e. treasury challan of Rs. 100 payable
into the Account No………. bearing No…….. dated to…….. be attached.
14. I declare that the above information. is correct and complete to the best of my knowledge and belief. I /We also undertake to observe provisions of the Antiquities and Art Treasures Act, 1972 and the rules made thereunder.
I also enclose an attested* copy of the Income-tax Certificate for the preceding year (19………..19……….. ) and the Registration No. of the business establishment. I also undertake to intimate any change of address or acquisition of new godown within week ** I also undertake to maintain such records, photographs and registers and furnish at my expense periodical returns with such particulars and photographs as may be required under the rules. I also undertake to make available every record, photograph and register maintained in this connection for the inspection of the licensing officer, or any other gazetted officer of Government authorized in writing by the licensing officer in this behalf.
Seal of the organization Name and signature of the applicant.
-------------------------------------------------------------------------------------------------------
Place…………. Date…………………
* Any change of address has to be promptly (within a week of shifting) intimated to the licensing officer.
** To be attested by a gazetted officer with seal of office.
| 