First Column | Second Column | Third Column | Fourth Column | Fifth Column |
---|---|---|---|---|
Note: A person duly authorised by the petroleum licensing authority to act in the following behalf shall enter– (a) in the first column, the address of the premises to which the Part III licence applies; (b) in the second column, the name of the licensee of those premises; (c) in the third column, the name of the petroleum licensing authority; (d) in the fourth column, his signature; and (e) in the fifth column, the date on which the Part III licence is issued. | ||||
Address of licensed premises | Name of licensee | Name of petroleum licensing authority | Signature of person issuing licence on behalf of petroleum licensing authority | Date of issue of Part III licence |