1. Name of the applicant. (In case the applicant is a firm or a company, the name of each of the partners of the firm or the directors of the company as the case may be).
   
   
2. Full address of the applicant. (In case the applicant is a firm or a company the full address of each of the partners of the firm or the directors of the company as the case may be).
   
   
3. In case the applicant is a firm or a company, the name (s) of its partner/partners or director/directors or duly authorised employees who will actually be engaged in the work of the Custom House -agents.
   
   
4. In case it is desired to appoint clerk (s) the name and address of the clerk (s) as the case may be.
   
   
5. Educational qualifications of each of the persons, who will actually be engaged in the work as Custom House Agent.
   
   
6. Particulars regarding knowledge of English and local language and Hindi.
   
   (These particulars are required in respect of each of the persons actually engaged in, the work as Custom House Agent).
   
   
7. Particulars regarding knowledge of Customs law and procedure. (These particulars are required in respect of each of the persons actually ~aged in the work of Custom House Agent).
   
   
8. Particulars of the quantity or value of cargo cleared during the currency of the temporary licence in acccordance with the Regulation 10.
   
   
9. Whether the applicant had earlier applied for a licence to act as a Custom House Agent and whether such application was rejected.
   
   
10. Whether he or the f1rnl or company by whom he is employed have earlier held a Custom House Agents Licence under these Regulations and whether it was cancelled or suspended.
    
    
11. Whether the applicant or any of the persons proposed to be employed by him have been penalised, convicted or prosecuted under any of the provisions of the Customs Act, 1962 or any other law for the time being in force. ..
    
    
12. Number and date of each of the documents furnished in accordance with Regulation 6.
    
    

                                                                   		Signature of applicant(s) 

                                                                   		1........................ 

		                                                                2........................ 
Date :.....................