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FORM 12

{See rule 11 A(4)} APPLICATION FOR REGISTRATION AS DEALER / VENDOR OF THE AGRICULTURAL PESTICIDES (To be rendered in triplicate) 1. Name of Applicant 2. Fathers Name. 3. Address of Applicant 4. No. & date of Certificate obtained for applying Pesticides. 5. Educational qualification. I do hereby apply for registration as a deale...

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