List of Forms

FORMS FOR REGISTRATION

EMBLEM

FORM ‘A’

[See Clause 8]

FORM OF APPLICATION TO OBTAIN DEALER’S (INDUSTRIAL)*

CERTIFICATE OF REGISTRATION

To,

the Controller (If the application is for industrial dealer’s certificate of

registration)

Place ......................... State of .............................

1. Full name and address of the applicant :

(a) Name of the concern, and postal address:

(b) Place of business (Please give exact address):

(i) for sale

(ii) for storage

2. Is it a proprietory/partnership/limited company/Hindu Undivided family

concern?

Give the name(s) and address(es) of proprietor/partners/manager/Karta:

3. In what capacity is this application filed.

(i) Proprietor

(ii) Partner

(iii) Manager

(iv) Karta

4. Whether the application is for wholesale or retail or industrial dealership?

5. Have you ever had a fertiliser dealership registration certificate in the past?

If so, give the following details :

(i) Registration number

(ii) Place for which granted

(iii) Whether wholesale or retail or industrial dealership.

(iv) Date of grant of registration certificate

(v) Whether the registration certificate is still valid?

(vi) If not, when expired?

(vii) Reasons for non-renewal

(viii) If suspended/cancelled and if so, when

(ix) Quantity of fertilisers handled during last year

(x) Names of products handled

(xi) Name of source of supply of fertilisers.

6. Was the applicant ever convicted under the Essential Commodities Act,

1955 or any Order issued thereunder including the Fertiliser (Control) Order,

1957 during the last three years preceding the date of application? If so

give details.

7. Give the details of the fertilisers to be handled

SI.No. Name of Fertiliser Source of supply

8. Please attach certificate(s) of source from the supplier(s) indicated under

column 3 of Sl.No.7.

9. I have deposited the registration fee of Rs. …………………..vide Challan

No....………dated ……….... in treasury / Bank or enclose the Demand

Draft No…………... dated……… for Rs........... drawn on ..............................

bank, in favour of..................... payable at........................................................

towards registration fee. (Please strike-out whichever is not applicable).

10. Declaration :-

(a) I/we declare that the information given above is true to the best of my/

our knowledge and belief and no part thereof is false.

(b) I/we have carefully read the terms and conditions of the Certificate of

Registration given in Form `B’ appended to the Fertiliser (Control)

Order, 1985 and agree to abide by them.

(c) I/we declare that I/we do not possess a certificate of registration for

industrial dealer and that I/we shall not sell fertilisers for industrial

use. (Applicable in case a person intends to obtain a wholesale dealer

or retail dealer certificate of registration, excepting a State

Government, a manufacturer or importer or a pool handling agency).

(d) I/we declare that I/we do not possess a certificate of registration for

wholesale dealer or retail dealer and that I/we shall not sell fertilisers

for agricultural use. (Applicable in case a person intends to obtain a

industrial dealer certificate of registration, excepting a State

Government, a manufacturer, importer or a pool handling agency).

Date Signature of the Applicant(s)

Place :

Note :

(1) Where the business of selling fertilisers is intended to be carried on at

more than one place, a separate application should be made for registration

in respect of each such place.

(2) Where a person intends to carry on the business of selling fertilisers both

in retail and wholesale, separate applications for retail and wholesale

business should be made.

(3) Where a person represents or intends to represent more than one State

Government, Commodity Board, Manufacturer/Importer or Wholesale

dealer, separate certificate of source from each such source should be

enclosed.

For use in Office of Controller

Date of receipt : Name and designation of

Officer receiving theApplication

EMBLEM

FORM `A1'

MEMORANDUM OF INTIMATION

[ See Clause 8(2)]

1. Details of the Notified Authority to whom application is submitted.

Designation of Notified Authority

Place

State of

2. Details of the applicant:

(a) Name of the applicant

(b) Name of the concern

(c) Postal address with telephone number

3. Place of business (Please give full address)

(i) For Sale

(ii) For Storage

4. Whether the application is for -

Manufacturer Importer Pool Handling Agency

Wholesale Dealer Retail Dealer

[Tick mark whichever is applicable]

5. Details of fertiliser and their source in Form ‘O’*

Name of fertiliser Whether certificate of source in Form

‘O’ is attached

(i) Yes No

(ii) Yes No

(iii) Yes No

[Please tick mark whichever is applicable]

6. I have deposited the registration fee of Rs. ______________________

vide Challan No. ___________________ Dated __________________

__________________________ in the Bank / Treasury___________

______________________________________________ or enclose

Demand Draft No. ________________________________ Dated ____

_____________ for Rs. ______________________ drawn on_______

______________ in favour of ________________________ payable

at _______________________ towards registration fees.

7. Whether the intimation is for an authorisation letter or a renewal thereof.

(Note: In case the intimation is for renewal of authorisation letter, the

acknowledgement in Form A2 should be submitted for necessary

endorsement thereon.)

8. Any other relevant information.

I have read the terms and conditions of eligibility for submission of Memorandum

of Intimation and undertake that the same will be complied by me and in

token of the same, I have signed the same and is enclosed herewith.

Date :

Place : Signature of applicant

*Attach a separate sheet if the number exceeds three.

Terms and conditions of authorisation

(1) I shall comply with the provisions of the Fertiliser (Control) Order,

1985 and the notifications issued thereunder for the time being in force.

(2) I shall from time to time report to the Notified Authority and inform about

change in the premises of sale depot and godowns attached to sale

depot.

(3) I shall also submit in time all the returns as may be prescribed by the State

Government.

(4) I shall not sell fertilisers for industrial use.

(5) I shall file a separate Memorandum of Intimation for, where the storage

point is located outside the area jurisdiction of the Notified Authority

where the sale depot is located

(6) I shall file a separate MOI for each place when the business of selling

fertilisers is intended to be carried on at more than one place .

(7) I shall file separate MOI if I carry on the business of fertilisers both as

retail and wholesale dealer.

(8) I confirm that my previous certificate of Registration or Authorisation is

not under Suspension or Cancellation or debarred from selling of

fertilisers.

DECLARATION

I/We declare that the information given above is true to the best of my/

our knowledge and belief and no part thereof is false or no material

information has been concealed.

Signature of the Applicant(s)

Date:

Place:

EMBLEM

FORM `A 2'

ACKNOWLEDGEMENT

[See Clause 8(3)]

Received from M/s _________________ a complete Memorandum of Intimation

alongwith Form O, fee of Rs. ________________by Demand Draft bearing

number ___________________________ dated __________________ .

2. this acknowledgement shall be deemed to be the letter of authorisation

entitling the applicant to carry on the business as applied for, for a period of 3

years from the date of issue of this Memo of acknowledgement unless

suspended or revoked by the competent authority.

Signature of Notified Authority

Dated :

Renewals

Received from M/S. __________________ a complete Memorandum of

Intimation alongwith Form O, fee of Rs. _______________by Demand Draft

bearing number ___________________________ dated ______________.

2. this acknowledgement shall be deemed to be the letter of authorisation

entitling the applicant to carry on the business as applied for, for a period of

3 years from the date of issue of this Memo of acknowledgement unless

suspended or revoked by the competent authority.

Dated : Signature of Notified Authority

EMBLEM

FORM ‘B’

[See Clause 9]

Book No Registration No.

Date of Issue

Valid upto

CERTIFICATE OF REGISTRATION TO CARRY ON thE BUSINESS

OF SELLING FERTlLISERS AS A *INDUSTRIAL DEALER IN thE

STATE OF

, is hereby granted certificate of registration to carry on the

business of selling fertilisers in retail/ wholesale/ for industrial use at the

place specified below in the State of ____________subject to the terms and

conditions specified below and to the provisions of the Fertiliser (Control) Order,

1985.

DESCRIPTION OF thE PLACE AND TYPE OF BUSINESS

Name and style Location of Location Type of Source of

by which the sale depot of godowns fertiliser supply

business is attached to

carried on sale depot

Date : Controller / Registering Authority

Seal : State of

Terms and conditions of certificate of registration:

(1) this certificate of registration shall be displayed in a prominent and

conspicuous place in a part of the business premises open to the public.

(2) the holder of the certificate shall comply with the provisions of the Fertiliser

(Control) Order 1985 and the notification issued thereunder for the time being in

force.

(3) the certificate of registration shall come into force immediately and be valid

upto ……….

Unless previously cancelled or suspended

(4) the holder of the certificate shall from time to time report to the Registering

Authority any change in the premises of sale depot and godowns attached to

sale depot.

(5) the wholesale dealer/retail dealer shall submit a report to the Registering

Authority, with a copy to the Block Development Officer or such other officer as

the State Government may notify, in whose Jurisdiction the place of business

is situated, by the 5th of every month, showing the opening stock, receipts,

sales and closing stocks of fertilisers in the preceding month. He shall also

submit in time such other returns as may be prescribed by the Registering

Authority.

(6) the Industrial dealer shall submit a report to the Central Government by the

15th of April for the preceding year, showing the opening stocks as on 1st of

April of the reporting year, sourcewise receipts during the year, sale and

closing stocks of fertilisers alongwith the sourcewise purchase/sale price.

(7) the wholesale or the retail dealer, except where such a dealer is a State

Government, a manufacturer, importer or a pool handling agency, shall not sell

fertilisers for industrial use and, as the case may be, an industrial dealer for

agricultural use.

Note : (a) the original is meant for the holder of the certificate which will be

delivered against his proper and adequate acknowledgement. the original

certificate of registration shall be torn off at the place perforated while all

duplicates shall be kept intact bound in the registration book by the Registering

Authority.

(b) Where the business of selling fertilisers is intended to be carried on at more

than one place, a separate registration certificate should be obtained in respect

of each such place.

(c) Where a person intends to carry on the business of selling fertilisers both in

retail and wholesale and, as the case may be, a State Government, a manufacturer,

importer or a pool handling agency, also for industrial use, separate registration

certificate should be obtained for retail and wholesale business and for sale for

industrial use.

EMBLEM

FORM ‘C’

[See Clause 11]

APPLICATION FOR RENEWAL OF thE CERTIFICATE OF

REGISTRATION TO CARRY ON thE BUSINESS OF SELLING

FERTlLISERS IN RETAIL/WHOLESALE / FOR INDUSTRIAL USE

To,

the Registering Authority/Controller (if the application is for Industrial dealer’s

certificate of Registration).

Place :

State :

I/we hereby apply for renewal of the certificate of registration to carry on the

business of selling fertilisers in retail/wholesale/ for industrial use under the

name and style of ___________________________the Certificate of

registration desired to be renewed was granted by Registering Authority for

the____________________________(mention place and state) and allotted

registration certificate No____________________ on the

_______________Day of __________ 20________ .

2. (i) I/we hereby declare that the situation of my/our premises where fertilisers

are (a) stored and (b) sold is as stated below:

(a) (b)

Premises where Premises where

fertilisers are stored fertilisers are sold

(ii) I/we hereby declare that the fertiliser(s) in which I/we am/are carrying on the

business of selling and the name(s) of manufacturer(s) /importer(s), Commodity

Board(s), State Govemment(s) and Wholesale Dealer(s) whom I/we represent are

as stated below:

(a) (b)

Name(s) of fertiliser(s) Name(s) of manufacturer(s)/ importer(s)

Commodity Board(s), Wholesale Dealer(s).

3. I/we enclose a certificate of source from the manufacturer(s), importer(s),

Commodity Board(s), State Government(s), Wholesale Dealer(s) whom I/we

represent or intend to represent and from whom fertiliser(s) will be obtained by

me/us.

4. I have deposited the renewal fee of Rs. ___________vide challan No.

____________ dated ___________ in Treasury/Bank ______________ or I

enclose the Demand Draft No. ______________dated ___________for Rs.

______________ drawn on _____________ Bank, in favour of __________

payable at _____________________ towards renewal fee (Please strike out

whichever not applicable).

Full Name and address of the Signature of applicant(s)

applicant(s) (in block letters)

Date :

Place:

Certified that the certificate of registration bearing number

________________granted on_________ for the period from

___________________to ________________ to carry on the business of

selling fertilisers in retail/wholesale/ for Industrial use at the premises situated at

________________is hereby renewed till the ___________ unless

previously suspended or cancelled under the provisions of the Fertiliser

(Control) Order 1985.

(a) (b) (c) (d)

Location of Location of Name(s) of Name(s) of

sale depot godowns attached fertiliser(s) for manufacturer(s),

to sale depot, which certificate Importer(s),

where fertilisers of registration is Commodity

will be stored renewed Board(s), State Government(s), Wholesale Dealer(s),whom the dealer represents

Date: Controller/Registering Authority

Renewal number : Place :

Seal State :

EMBLEM

FORM ‘D’

[See clause 14(2) and 18(1)]

FORM OF APPLICATION TO OBTAIN A CERTIFICATE OF

MANUFACTURE OF PHYSICAL/GRANULATED MIXTURE

OF FERTILISER OR ORGANIC FERTILISER /BIOFERTILISER

To

the Registering Authority

Place____________________

State of __________________

(1) Full name and address of the applicant:

(2) Does the applicant possess the qualification prescribed by the State

Government under sub-clause (1) of clause 14 of the Fertiliser (Control)

Order, 1985.

(3) Is the applicant a new comer? (Say ‘Yes’ or ‘No’)

(4) Situation of the applicant’s premises where physical/granulated mixture

organic fertiliser/biofertiliser will be prepared:

(5) Full particulars regarding specifications of the physical/granulated mixture

of fertilisers/organic fertiliser/biofertiliser for which the certificate is required

and the raw materials used in making the mixture.

(6) Full particulars of any other certificate of manufacture, if any, issued by any

other Registering Authority;

(7) How long has the applicant been carrying on the business of preparing

physical/granulated mixture of fertilisers/organic fertiliser/biofertiliser/

mixture of micronutrient fertilisers?

(8) Quantities of each physical/granulated mixture of fertilisers/mixture of

micronutrient fertilisers/organic fertilisers/ biofertilisers (in tonnes) in my/

our possession on the date of the application and held at different addresses

noted against each;

(9) (i) If the applicant has been carrying on the business of preparing

physical/granulated mixtures of fertilisers/mixture of micronutrient

fertilisers/organic fertiliser/ biofertiliser, give all particulars of such mixtures

handled, the period and the place (s) at which the mixing of fertilisers was

done;

(ii) Also give the quantities of physical/granulated fertiliser mixture organic

fertiliser/biofertiliser handled during the past calendar year;

(10) If the application is for renewal, indicate briefly why the original certificate

could not be acted on within the period of its validity.

Declaration

(a) I have deposited the prescribed registration certificate fee/renewal fee.

(b) I/we declare that the information given above is true and correct to the best

of my/our knowledge and belief, and no part there is false.

(c) I/we have carefully read the terms and conditions of the certificate of

manufacture given in Form F appended to the Fertiliser (Control) Order,

1985 and agree to abide by them.

(d) I/we declare that the physical/granulated mixture/organic fertiliser/biofertiliser

for which certificate of manufacture is applied for shall be prepared

by me/us or by a person having such qualifications as may be prescribed

by the State Government from time to time or by any other person under

my/our direction, supervision and control or under the direction, supervision

and control of person having the said qualification.

(e) I/we declare that the requisite laboratory facility specified by the Controller,

under this Order is possessed by me/us.

Name and address of applicant

in block letters:

Date:

Place:

Signature of applicant(s)

  EMBLEM

FORM ‘E’

[See Clause 14(2) (b)]

FORM OF APPLICATION TO OBTAIN A CERTIFICATE OF

MANUFACTURE FOR SPECIAL MIXTURE OF FERTILISERS

To,

the Registering Authority

Place_______________ State ________________

(1) Full name and address of the applicant:

(2) Does the applicant possess qualifications prescribed by the State

Government under sub-clause (1) of 14 of the Fertiliser (Control) Order,

1985.

(3) Name and address of the person requiring the special mixture of fertilisers:

(4) Particulars of certificate(s) of manufacture already obtained from the same

Registering Authority:

(5) Situation of the applicants premises where fertilisers are/will be mixed:

(6) Full particulars regarding specifications of the special mixture of fertilisers

required to be manufactured and the materials used in making the special

mixture:

(7) I am enclosing an attested copy of the requisition made by the purchaser

of the special mixture of fertilisers:

(8) I have deposited the prescribed registration certificate fee:

Declaration :

(a) I/We declare that the information given above is true and correct to the

best of my/our knowledge and belief, and no part thereof is false.

(b) I/we have carefully read the terms and conditions of the certificate of

manufacture given in Form “G’ appended to the Fertiliser (Control) Order

1985 and agree to abide by them.

(c) I/we declare that the special mixture for which a certificate of manufacture

is applied for, shall be prepared by me/us or by a person having such

qualifications as may be prescribed by the State Government from time to

time or by any other person under my/our direction, supervision and

control or under the direction, supervision and control of a person having

the said qualifications.

(d) I/we declare that the requisite laboratory facility specified by the Controller

under this Order is possessed by me/us.

Name and Address of the applicant(s) Signature of the applicant(s)

in block letters:

Date:

Place:

EMBLEM

FORM ‘F’

[See clause 15(2) and 18(2)]

Book No. Certificate No.

Date of issue

Valid upto

CERTIFICATE OF MANUFACTURE IN RESPECT OF

PHYSICAL/GRANULATED MIXTURE/ORGANIC

FERTILISER/BIOFERTILISER

___________(Name of Manufacturer) is hereby given the certificate for

manufacture of the physical/granulated mixture/organic fertiliser/biofertiliser

specified below subject to the terms and conditions of this certificate and to the

provisions of the Fertiliser (Control) Order, 1985.

Full particulars of the granulated/physical Full address of the premises

mixture of fertiliser, organic fertiliser/ where the mixture of fertiliser or

biofertiliser mixture of micronutrient fertilisers,

organic fertiliser/biofertiliser will

be made

Date: Registering Authority:

Seal: State:

Renewed upto___________

Date: Registering Authority:

Seal: State:

Terms and conditions of this certificate

(1) the holder of this certificate shall display the original thereof in a

conspicuous place open to the public in a part of the principal’s premises in

which business of making the physical/granulated mixture/organic fertiliser/

biofertiliser is carried on and also a copy of such certificate in similar manner

in every other premises in which that business is carried on. the required

number of copies of the certificate shall be obtained on payment of the fees

thereof.

(2) the holder of this certificate shall not keep in the premises in which he

carries on the business of making physical/granulated mixture of

biofertilisers/organic fertiliser in respect of which a certificate of registration

has not been obtained under the Fertiliser (Control) Order, 1985.

(3) the holder of this certificate shall comply with the provisions of the Fertiliser

(Control) Order, 1985 and the notification, order and direction, issued thereunder

for the time being in force.

(4) the holder of the certificate shall report forth with to the Registering

Authority any change in the premises specified in the certificate or any new

premises in which he carried on the business of making physical/granulated

mixture/organic fertiliser/biofertiliser and shall produce before the authority

the original certificate and copies thereof so that necessary corrections

may be made therein by that authority.

(5) the holder of this certificate shall ensure that the physical/granulated

mixture/organic fertiliser/biofertiliser in respect of which a certificate of

registration has been obtained is prepared by him or by a person having

such qualifications, as may be prescribed by the State Government, from

time to time or by any other person under the direction, supervision and

control of the holder or the person having the said qualifications.

(6) the certificate and copies thereof, if any, will be machine numbered and

delivered against the signature of the holder thereof or his agent on the

carbon copy of the certificate which will be kept intact bound in the

“Certificate Book” by each Registering Authority.

EMBLEM

FORM ‘G’

[See Clause 15(2)]

Book No.____________ Certificate No._________________

Date of issue _________________

CERTIFICATE OF MANUFACTURE IN RESPECT OF thE SPECIAL

MIXTURE OF FERTILISERS

__________________ is/are hereby given this certificate for the preparation of

___________________tonnes of special mixture of fertilisers specified below

subject to the terms and conditions of this certificate, and to the provisions of

the Fertiliser (Control) Order, 1985.

Full particulars of the special mixture of fertilisers

2. the certificate is valid upto _________________________________

Full address of the premises where the special mixture of fertilisers will be

made

Date : Registering Authority :

Seal : State :

Terms and conditions of this certificate :

(1) the holder of the certificate shall display the original thereof in a

conspicuous place open to the public in a part of the principal premises in

which the business of making the special mixture of fertilisers is carried on

and also a copy of such certificate in similar manner, in every other premises

in which that business is carried on.

the required number of copies of the certificate shall be obtained on

payment of fees therefor.

(2) the holder of this certificate shall not keep in the premises in which he

carries on the business of making special mixture of fertilisers, any mixture

of fertilisers in respect of which a certificate of manufacture has not been

obtained under the Fertiliser (Control) Order, 1985.

(3) the holder of the certificate shall comply with the provisions of the Fertiliser

(Control) Order, 1985 and the notification, orders, and directions issued

thereunder for the time being in force.

(4) the holder of this certificate shall report forthwith to the Registering

Authority any change in the premises specified in the certificate or any

new premises in which he carries on the business of making the special

mixture and shall produce before the authority the original certificate and

copies thereof so that necessary corrections may be made therein by that

authority.

(5) the holder of this certificate shall ensure that the special mixture in respect

of which a certificate of manufacture has been obtained is prepared by

him or by a person having such qualifications as may be prescribed by the

State Government from time to time or any other person under the direction,

supervision and control of the holder or person having the said

qualifications.

Note : the certificate and copies thereof, if any, will be machine numbered

and delivered against the signature of the holder thereof or his agent on

the carbon copy of the certificate which will be kept intact bound in the

"Certificate Book" by each Registering Authority.

EMBLEM

FORM ‘H’

[See Clause 23 (1) (b)]

APPLICATION FOR GRANT OF PERMISSION

TO SELL NON-STANDARD FERTILISERS

To,

the Notified Authority

State of____________

(1) Full name and address of the applicant:

(2) the name of fertilisers in which the applicant has been authorised to carry

on business:

(3) Number and date of authorisation letter granted in favour of the applicant:

(4) the particulars of non-standard fertilisers which are intended to be sold:

(i) Name of the fertiliser:

(ii) the source from which the fertilisers were originally purchased and the

period during which they have been held by the applicant.

(iii) Brief reasons leading to the material having become non-standard.

(iv) the chemical specifications as analysed by an authorised chemical

laboratory:

(v) Name and appearance of the non-standard fertilisers.

Note : Chemical analysis to be indicated shall be one which has been certified

by a notified Fertiliser Control Laboratory on the basis of samples drawn by the

Fertiliser Inspector.

I enclose a copy of the authorisation letter for dealing in fertilisers already

granted to me and I have deposited the prescribed fee for permission to sell

non-standard fertilisers.

I certify, that I will comply with the requirements of sub-clause (a) of clause 23

of the Fertiliser (Control) Order, 1985 which requires that each container of

non-standard fertilisers is to be conspicuously superscribed with the words

“Non-standard" and also with the sign ‘X’ both in red colour.

Signature of the applicant

Name and address of applicant in block letters

Date :                                                   Place:

EMBLEM

FORM ‘I’

[See Clause 23(1) (b)]

Book No. __________ Date of issue _________________

Valid upto ____________________

AUthORISATION FOR thE SALE OF

NON-STANDARD FERTILISERS

M/s.________________ is/are hereby permitted to sell the non-standard

fertilisers described below subject to the terms and conditions noted hereunder.

Particulars of non-standard fetiliser

(1) Name of the fertiliser.

(2) Detailed chemical specifications including the nutrient content.

(3) Nature and appearance of the non-standard fertiliser.

(4) Place of location of the non-standard fertiliser.

Terms and conditions:

(1) the seller of the non-standard fertiliser described above shall comply with

the provisions of sub-clause(a) of Clause 23 of the Fertiliser (Control)

Order, 1985.

(2) the non-standard fertilisers described above shall be sold at a price not

exceeding __________ per metric tonne or _____ per bag of _______kgs.

(3) the non-standard fertiliser described above shall be sold before the expiry

of the validity period mentioned above or before the expiry of the extended

period, if any.

Date :                                                                                                                           Notified Authority

State of

Seal :

EMBLEM

FORM ‘J’

[See Clause 28 (1) (b)]

FORM INDICATING PARTICULARS OF

FERTILISERS SAMPLED

(1) Name and address of dealer/manufacturer/importer

(1A) Certificate of Registration Number

(2) Date of sampling

(3) Details of markings on bags from where sample has been taken

(i) Type and grade of fertiliser

(ii) Name of manufacturer/importer

(iii) Omitted vide S.O. 49(E) dt.16.01.03

(iv) Batch No. (if applicable) and date of manufacture/import

(v) Composition

(4) Date of receipt of the stock by the dealer/manufacturer/importer/pool

handling  agency

(5) Code No. of sample

(6) Stock position of the lot

(7) Physical condition of fertiliser

(8) Whether samples drawn from open bags or stitched bags

(9) Name & Address of Fertiliser Inspector drawing sample

Signature & Metallic Seal

impression of Fert. Inspector

Receipt of the dealer

Certified that the sample of fertiliser has been drawn in accordance with the

procedure laid down in the Fertiliser (Control) Order, 1985 from the stock in my

possession, and I have signed the test samples at the time of wax sealing. I

have also received one test sample out of the three test samples prepared.

Signature of dealer/

manufacturer/importer/

Pool handling agency with address

Signature & seal of

Fertiliser Inspector

EMBLEM

FORM ‘J-1’

[See clause 28 (bb)]

FORM INDICATING PARTICULARS OF

ORGANIC FERTILISER/ BIOFERTILISERS SAMPLED

(1) Name and address of dealer/manufacturer/importer ______________

(1A) Certificate of Registration Number____________________

(2) Date of sampling_______________________________

(3) Details of markings of bags from where sample has been taken _________

________________________________________________________

(i) Type of organic fertiliser/biofertiliser ______________________

(ii) Name of manufacturer/importer____________________________

(iii) Batch No. (if applicable) and date of manufacture/import________

(iv) Composition ___________________________

(4) Date of receipt of the stock by the dealer/manufacturer/importer/pool

handling agency_______________________________________

(5) Code No. of sample_____________________________________

(6) Stock position of the lot__________________________________

(7) Physical condition of organic fertiliser/biofertiliser ________________

(8) Whether samples drawn from open bags or stitched bags/with sealed

packet_____________________

(9) Name and Address of organic fertiliser/biofertiliser Inspector drawing

sample______________________

For organic fertiliser

Signature and Metallic Seal

impression of Fertiliser Inspector

Receipt of the dealer

Certified that the sample of organic fertiliser/biofertiliser has been drawn in

accordance with the procedure laid down in the Fertiliser (Control) Order, 1985

from the stock in my possession, and I have signed the test samples at the time

of wax sealing. I have also received one test sample out of the three test samples

prepared.

Signature and Seal of

Fertiliser Inspector

Signature of dealer/manufacturer/

importer/pool handling agency

with address

EMBLEM

FORM ‘K’

[See Clause 30 (I)]

MEMORANDUM TO ACCOMPANY FERTILISER

SAMPLE FOR ANALYSIS

No.

From

To,

Incharge

Fertiliser Quality Control Laboratory

the fertiliser samples as per details given below are sent for analysis :-

(1) Name of fertiliser, grade _________________________________

(2) Date of sampling ______________________________________

(3) Omitted vide S.O. 49(E) dt.16.01.03_________________________

(4) Omitted vide S.O. 49(E) dt.16.01.03_________________________

(5) Physical condition of fertiliser _____________________________

(6) Code number of sample ___________________________________

2. the analysis report may please be forwarded to ____________________

__________________________________________________________

Signature and metallic seal

impression of Fertiliser Inspector

Place :

Date :

EMBLEM

FORM ‘K-1’

[See clause 30]

MEMORANDUM TO ACCOMPANY ORGANIC FERTILISER/BIOFERTILISER

SAMPLE FOR ANALYSIS

No.

From

________________________________

________________________________

To,

Incharge

Organic fertiliser/Biofertiliser Quality Control Laboratory

the biofertiliser samples as per details given below are sent for analysis:-

(1) Name of organic fertiliser/biofertiliser _____________________

(2) Date of sampling______________________________________

(3) Physical condition of organic fertiliser/biofertiliser ____________

(4) Code number of sample_________________________________

2 the analysis report may be forwarded to__________________________

____________________________________________________________

Place:

Date:

Signature and metallic seal

impression of Fertiliser Inspector

EMBLEM

FORM ‘L’

[See Clause 30(2)]

ANALYSIS REPORT OF FERTILISER SAMPLE

No.

Government of

(Name of the Laboratory)

Date

To,

the Fertiliser Inspector

………………………..

………………………..

the analysis report of the fertiliser sample forwarded vide your reference

No. …………………….... Dated ………………… is as per details given below :

(1) Name of fertiliser, grade

(2) Date of sampling

(3) Omitted vide S.O. 49(E) dt.16.01.03

(4) Code No. of sample as indicated by the Inspector

(5) Date of receipt of the sample in the laboratory

(6) Laboratory sample No

(7) Date of analysis of sample

(8) Chemical analysis of fertiliser (on fresh weight basis except in the case

of Urea on dry weight basis)

 (i) Moisture

(ii) Total N

(iii) NH4N

(iv) NH4.NO3N

(v) Urea N

(vi) Total P2O5

(vii) Neutral ammonium

citrate soluble P2O5

(viii) Citric acid soluble P2O5

(ix) Water soluble P2O5

(x) Water soluble K2O

(xi) Particle size

(xii) Others

____________________________________________________________________________________

Remarks :- the sample is/is not according to specifications and fails in......................

Signature of the Incharge

Fertiliser Quality Control Laboratory

Copy to :-

Director of Agriculture

EMBLEM

FORM ‘L – 1’

(See clause 30 )

ANALYSIS REPORT OF ORGANIC FERTILISER SAMPLE

No.____________________

Government of _________________________

_____________________________________

_____________________________________

(Name of the Laboratory)

Date_____________________

To

the Fertiliser Inspector

____________________________________

____________________________________

the analysis report of the organic fertiliser sample forwarded vide your reference

No.______________________________Dated_________________is as per details given below:

(1) Name of Organic fertiliser

(2) Date of Sampling

(3) Code No. of sample as indicated by  the Inspector

(4) Date of receipt of the sample in the Laboratory

(5) Laboratory sample No.

(6) Date of analysis of sample

(7) Analysis of Organic Fertiliser (on fresh weight basis)

 (A) Physical Characteristics –

(i) Moisture content

(ii) Bulk density

(iii) Particle size

(B) Chemical Characteristics –

(i) Total Organic Carbon

(ii) Total Nitrogen

(iii) C:N

(iv) Phosphorus

(v) Potassium

(vi) pH

(vii) Conductivity

(C) Heavy Metal

(i) Cadmium

(ii) Chromium

(iii) Copper

(iv) Mercury

(v) Nickel

(vi) Lead

(vii) Zinc

Remarks : the sample is/is not according to specification and fails in__________

Signature of the Incharge

(Testing Laboratory

Copy to:-

Director of Agriculture

EMBLEM

FORM ‘L – 2’

[See clause 30]

ANALYSIS REPORT OF BIOFERTILISER SAMPLE

No.

Government of

(Name of the Laboratory)

Date

To

the Fertiliser Inspector

the analysis report of the biofertiliser sample forwarded vide your reference

No.__________________________Dated_________________is as per details given below:

(1) Name of Biofertiliser

(2) Date of Sampling

(3) Code No. of sample as indicated by

by the Inspector

(4) Date of receipt of the sample in the

Laboratory

(5) Laboratory sample No.

(6) Date of analysis of sample

(7) Analysis of biofertiliser (on fresh weight basis)

 (A) Physical Characteristics

(i) Moisture content

(B) Chemical Characteristics

(i) pH

____________________________________________________________________________________

(C) Microbial Characteristics

(i) Viable Cell Count

(ii) Contamination Level

____________________________________________________________________________________

(D) Efficiency Characteristics

*(i) Nodulation Test

**(ii) Nitrogen fixed (mg)/g of

sucrose consumed

*** (iii) Formation of white

pellicle in semi solid

Nitrogen free bromothymol

blue media

+(iv) (a) Solubilization zone (mm)

(b) P- phosphorus (%)

Spectro-photometer.

____________________________________________________________________________________

*Rhizobium, ** Azotobacter, *** Azospirillum, + PSM

Remarks : the sample is/is not according to specification and fails in ___

___________________________________________________________

___________________________________________________________

Signature of the Incharge

(Testing Laboratory)

Copy to:-Director of Agriculture

EMBLEM

FORM ‘L – 3’

[See clause 30]

ANALYSIS REPORT OF NON-EDIBLE

DE-OILED CAKE FERTILISER SAMPLE

No.

Government of

(Name of the laboratory)

Date

To

the Fertiliser Inspector

the analysis report of the non-edible de-oiled cake fertiliser sample forwarded

vide your reference No. -------------dated---------------------- is as per details given  below :

(1) Name of Non-edible de-oiled cake fertiliser

(2) Date of sampling

(3) Code no. of sample as

indicated by the inspector.

(4) Date of receipt of the

sample in the laboratory

(5) Laboratory sample No.

(6) Date of analysis of sample

(7) Analysis of non-edible de-oiled cake fertilizer (on fresh weight basis

 (A) Physical Characteristics :

(i) Moisture content ............................

(ii) Particle size ...............................

(B) Chemical Characteristics :

(i) Total organic carbon

(ii) Total nitrogen

(iii) C:N

(iv) Phosphorus

(v) Potassium

(vi) pH

(vii) Conductivity

(viii) Total ash

(ix) Others

Remarks : the sample is/is not according to specification and fails in

Signature of the incharge

(Testing Laboratory)

Copy to :

Director of Agriculture

EMBLEM

FORM ‘M’

[See Clause 5]

FORM FOR CASH/CREDIT MEMORANDUM TO BE ISSUED

BY thE DEALER/MANUFACTURER/IMPORTER/POOL

HANDLING AGENCY TO thE PURCHASER OF FERTILISERS

ST/CST No……………………….

Sl.No………………………                                                                       Date ………………………......

Certificate Registration No. …...........................………………..........…….

Name and Address of Firm : …...………………………………................…

Name and Address of Purchaser : …………………………….……........….

1.

2.

x.

xx.

Total :

ST/CST @

Signature of purchaser

Signature of dealer, etc.

EMBLEM

FORM ‘N’

[See Clause 35(1) (a)]

FORM FOR STOCK REGISTER TO BE MAINTAINED BY thE

DEALER/ MANUFACTURER/IMPORTER/POOL

HANDLING AGENCY

Page Number : ___________

Name of the Fertiliser :_________________________________________

1. Mention

source

of supply

with bill

No. and date

2. Sl. No. of

first and

last cash/

                          credit memo

issued

______________________________________________________________________________

Note : the pages of the stock register should be numbered. A Certificate should be recorded by the inspecting authority confirming the pages in the register.

EMBLEM

FORM ‘O’

[See Clause 8 and 11]

CERTIFICATE OF SOURCE FOR CARRYING ON

thE BUSINESS OF SELLING FERTILISERS IN

WHOLESALE/RETAIL FOR INDUSTRIAL USE

No. __________________          Date of issue ____________________

1. Particulars of the concern issuing the certificate of source

(a) Name and full address

(b) Status :                                            (i)  State Government

                                                 (ii)  Manufacturer

(iii)  Pool handling agency

          (iv)  Wholesale dealer

                                                  (v )  Importer

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

manufacture of mixture of fertilisers possessed :

(i)         Number

       (ii)        Date of issue

       (iii)                   Date of expiry

                      (iv)       Grades of mixturers of fertilisers

                                    allowed to be manufactured

                         (v)        Authority by whom issued

(d) Details of certificate of registration :

   (i)       Number

                                                                   (ii)      Date of issue

(iii)    Date of expiry

                   (iv)     Authority by whom issued

2. Particulars of the person to whom the certificate of source is being issued

(a) Name and full address

(b) Status :

(i)  Wholesale dealer

(ii)   Retail dealer

(iii)   Industrial dealer

(c) If holds a valid certificate of registration, the details thereof :

(i)      Number

(ii)    Date of issue

 (iii)   Date of expiry

               (iv)   Authority by whom issued

(d) Purpose of obtaining the certificate of source :

       (i)    For obtaining a fresh

                 certificate of registration

(ii)   For renewal of the

                certificate of registration

1.     Details of fertiliser(s) to be supplied :

1.

2.

3.

_________________________________________________________________________________

4. 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.

Signature with stamp of the

Authorised Officer

EMBLEM

FORM ‘P’

[See Clause 28(1)(b)]

PARTICULARS OF SAMPLE DRAWN

1. Name and Grade of Fertiliser :

2. Composition :

3. Physical Condition of Fertiliser :

4. Code No. :

5. Date of Sampling :

6. Name & Address of Fertiliser Inspector drawing sample :

Signature and Metallic Seal

Impression of Fertiliser Inspector