P.O.Box: ____________________ Fax: ____________________ Mobile: ____________________ Tel: ____________________ E-Mail ____________________
• Company Name: ____________________ • Lic No: __________ • Licence Type ____________________ • Licence Status: ☐ Renewal /Amendment ☐ Amendment Only • Facility Type: ____________________ • Categories Name: ☐ Group (1) Code / Name: ____________________ ☐ Group (2) Code / Name: ____________________
| NO | Code | Proposed Activity (New) |
|---|---|---|
| 1 |