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Fire Crackers License Application Form
Name of Applicant
Father/Husband Name
Date of Birth (mm/dd/yyyy)
Applicant's Full Address
District
Imphal West
Imphal East
Thoubal
Bishnupur
Kakching
Chandel
Tengnoupal
Ukhrul
Kamjong
Senapati
Pherzawl
Noney
Jiribam
Churachandpur
Tamenglong
Kangpokpi
Sub-Division of the Venue
Lamphel
Lamsang
Wangoi
Patsoi
Pin Code
Email
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.