e-District Manipur | Government of Manipur

Name of Applicant

Father/Husband Name

Date of Birth (mm/dd/yyyy)

Applicant's Full Address

District

Sub-Division of the Venue

Pin Code

Mobile Number

Place of Shop

License From (mm/dd/yyyy)

License To (mm/dd/yyyy)

Declaration :

I do hereby declared that the particulars furnished in this form are true to the best of my knowledge.