Tamil Nadu Marine Fishing Regulation Rules, 1983

Form V

Application for the issue of Duplicate Licence or Certificate of Registration.

(See rule 5 of the Tamil Nadu Marine Fishing Regulation Rules, 1983).

(1)	Name of the applicant		..	..	..
(2)	Father's Name	..	..	..	..
(3)	Present Address	..	..	..	..
(4)	Number and date of the licence or registration certificate for which duplicate is sought for.
(5)	Reason for applying for the issue of duplicate licence or registration certificate.
(6)	Period for which the original licence or registration certificate is valid.
(7)	Details of the fee paid	..	..	..

I, hereby declare that the information furnished above are true to the best of my knowledge and belief. I agree to obey the orders of the authorised officer and abide by the provisions of the Tamil Nadu Marine Fishing Regulation Act, 1983.

I also agree to return the duplicate licence/certificate of registration if the original is traced.

Place:
Date:

Signature / Thumb impression of the applicant.