Mobile No/मोबाइल नंबर : [*]

Name of Rice Mill/राईस मिल का नाम : [*]

Address/पता : [*]

Name of Applicant/आवेदक का नाम : [*]

Email Id/ईमेल आईडी: [*]
Email is not vaild.

Address of MD/Prop./Partner : [*]

Pincode/पिन कोड : [*]

Landmark :

Owner Mobile No : [*]

Ownership/स्वामित्व : [*]
Select Proprietor Partner Company

Aadhaar Number/आधार नंबर : [*]

Memorandum of Association / Byelaws/मेमोरेंडम ऑफ एसोसिएशन / Byelaws : [*]

Yes

No

*

Industry License No./उद्योग लाइसेंस सं : [*]

License Type/लाइसेंस के प्रकार : [*]
Select Permanent Temporary

License valid Date : [*]
*

GST NO/जी॰अस ॰टी॰ सं : [*]

Pollution NOC No./प्रदूषण एनओसी नं :

Pollution date/प्रदूषण की तारीख : [*]
*

Pollution Valid Till date/प्रदूषण मान्य तिथि तक : [*]

Type of Mill/मिल का प्रकार: [*]
Select Raw Per Boiled

Milling Shift/मिलिंग शिफ्ट : [*]
Select Morning Shift (8hr) Morning & Evening Shift (16hr) Morning , Evening & Night Shift (24hr) *

FSSAI License Number: [*]

FSSAI License Number Issued On : [*]
*

FSSAI License Number Valid Upto: [*]
*

FSSAI Document : [Only PDF][*]

+F Endorsement certificate NO: [*]

+F Endorsement Issued On Date : [*]
*

+F Endorsement Valid Upto Date: [*]
*

+F Endorsement Document : [Only PDF][*]

Only Accept pdf

Boiller license Number :[*]

Boiller license Number Issued On Date : [*]
*

Boiller license Number Valid Upto Date : [*]
*

Boiller Capacity Per Hour (In MT) :[*]

Dryer Capacity Per Hour (In MT) :[*]

Stoner : [*]

Yes

No

*

Double Polisher : [*]

Yes

No

*

Grader : [*]

Yes

No

*

Blending Machine: [*]
Select Dynamic Automatic *

Acceptance for Advance CMR/अग्रिम सीएमआर के लिए स्वीकृति : [*]

Yes

No

*

Password : [*]

Password must be 8 characters and have both letters and numbers.

Confirm Password : [*]

Password and Confirm Password is not match. Password must be 8 characters and have both letters and numbers.