FORM 106

(See rule 13)

Declaration /Revised declaration regarding Manager or Managers of the business.

________________________________________________________________________________________

Registration Number ----------------------

Name of the registered dealer------------------------------------------------------------------------

________________________________________________________________________________________

I furnish herewith the declaration/*revised declaration in supersession of Previous declaration under section 65.

Shri....................................................who is..........................................

(mention here the designation or status) shall at all time comply with the provision of the said Act and rules made there under.

Counter Signature of the person nominated ------------------------------------------

Status of the person nominated --------------------------------------------------------

Signature of the registered dealer ------------------------------------------------------

Date: -------------

* Strike out which is not necessary.