FORM III

 

FORM III

(Application for extension or renewal of certificate of practice)

To,
The [Central / State] Government
(Secretary, Ministry of Law and Justice / Law Department),
New Delhi / [State Capital].

Sir,
I hereby apply for extension/renewal of my certificate of practice as a notary, which was issued under certificate no. __________ dated __________ and is due to expire on __________.

1. Name (in full): ___________________________

2. Father’s/Husband’s Name: ___________________________

3. Address: ___________________________

4. Date of initial appointment: ___________________________

5. Area or areas of practice: ___________________________

6. Whether any disciplinary proceedings have been initiated or are pending against you: ___________________________

7. Details of fees paid for extension/renewal: ___________________________

I hereby declare that the particulars given above are true and request that my certificate be extended / renewed for a further period of five years.

Place: ___________________
Date: ___________________
(Signature of applicant)