FORM -"C"

[See Regulation 10]

(Regular Licence)
Application Form for rant of Cu!tom "ou!e Agent! Licence un#er Section 1$% of t&e Cu!tom!
Act' 1(%)
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
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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).
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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 ustom
!ouse "agents.
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4. In case it is desired to appoint clerk (s) the name and address of the clerk (s) as the case may be.
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5. #ducational $ualifications of each of the persons, who will actually be engaged in the work as
ustom !ouse %gent.
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&. 'articulars regarding knowledge of #nglish and local language and !indi.
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((hese particulars are re$uired in respect of each of the persons actually engaged in, the work as
ustom !ouse %gent).
7. 'articulars regarding knowledge of ustoms law and procedure. ((hese particulars are re$uired in
respect of each of the persons actually )aged in the work of ustom !ouse %gent). .
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8. 'articulars of the $uantity or *alue of cargo cleared during the currency of the temporary licence in
acccordance with the +egulation 1,. .
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9. -hether the applicant had earlier applied for a licence to act as a ustom !ouse %gent and
whether such application was re.ected. .
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10. -hether he or the f1rnl or company by whom he is employed ha*e earlier held a ustom !ouse
%gents /icence under these +egulations and whether it was cancelled or suspended. .
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11. -hether the applicant or any of the persons proposed to be employed by him ha*e been penalised,
con*icted or prosecuted under any of the pro*isions of the ustoms %ct, 10&1 or any other law for
the time being in force. .
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12. Number and date of each of the documents furnished in accordance with +egulation &. .
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I/-e hereby affirm that I/we ha*e read the ustom !ouse %gents /icensing +egulations, 1023 and agree
to abide by them.
4ignature of applicant(s)
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5ate 6.....................