Madhya Pradesh Shops & Establishments Act, 1958

Application for Establishment Registration

Docket No. 457482

Date of Application : 25/12/2016

Name of Applicant : sunil agrawal

Father's / Husband's Name : kishori lal agrawal
Applicant's Status : Proprietor/Owner
Mobile No. : 8305696274
Address of Applicant : fort road rewa
Name of Shop / Establishment : agrawal stationary mart
Address: fort road rewa

District : REWA

Shop Type (Employee Wise) : No Employees

Day of Weekly Off : Sunday

Old Registration No. (if Any):

Owner Type : Proprietorship

Business Type : Book / Stationery

Category of Shop/Establishment : Shop

Business Start Date : 22/12/2016

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DECLARATION
I, sunil agrawal S/o / D/o / W/o. Mr. kishori lal agrawal do hereby solemnly affirm and declare that all information furnished by me online and
original documents scanned & uploaded by me along with this application are true to the best of my knowledge and belief and I shall be
responsible for any kind of false or fraudulent information and my Registration will be liable to be cancelled or withheld in any such case
without prior notice besides any other criminal/civil proceedings against me.

Signature of Applicant