2. Notarised affidavit - Delhi Police : LICENSING BRANCH

Affix self attested photoAffidavit(for the grant of fireworks licence permanently)(Specimen of affidavit to be submitted by applicants on non-judicialstamp paper of worth Rs. 10/- duly attested by a Notary Public forthe grant of permanent fireworks licence)I/we, _______________Son/Daughter/Wife of__________________presently residing at_______________________________ since __________ dosolemnly affirm and declare as follows:• That my date of birth is ________ (day __month year )(Attach copy of DOB)• That I am permanent resident of________________________________(attach proof).• That I am medically fit. (attach a medical certificate issued bya registered MBBS Doctor).• That my nominee shall be Shri/Smt.________________________who is my___________(relationship) and residing at_______________________________• That I have applied for permanent fireworks licence at theproposed premises located at(attach proof)• That I am/was not involved in any criminal case.• That I have never been externed from my place of stay by anyjudicial authority and neither am I a proclaimed offender ofany state Govt. or of Delhi Police, and to the best of myknowledge there is no Red Corner Notice or any other LookOut notice pending against me.• That I have also no proceedings /cases instituted against mein the CBI, NCB, Enforcement Directorate, Directorate of

• The road width on the side of the premises is more than 12metres with entry and exit facing the road.• That I will make requisite arrangements for keeping the stockof fire crackers in safe place and to avoid access of childrenand other unauthorized persons to the fire crackers in thelarger public interest.• That I require a permanent fireworks licence because (Givefull justification).• I shall always keep all fire safety arrangements and I will beliable for any mishappening.• That I shall not employ children/juvenile in the shop.• I will ensure that the upper floor of the shop is not used as adwelling unit.The particulars furnished by me above are true & correct tothe belief of my knowledge and I have not concealed ormispresented any facts.DEPONENTATTESTEDSignature and official seal of notary public