FORM IV
[See sub-rule (2) of rule 5]

Application for permission to purchase specified animal, etc.
To
The ____________________
________________________
________________________
Sir,
I/We _________________ residing at ____________,Taluk __________________, District ______________, request that I/We may be granted permission to purchase specified animal/animal article/trophy/uncured trophy derived from specified animal of the following description, from a Licence:-
(1) Number and description of
(a)  Specified animal _______________________________________________
(b) Animal article _________________________________________________
(c) Trophy ______________________________________________________
(d) Uncured trophy _______________________________________________
(2) Purpose for which the purchase is to be made ___________________________
(3) I/We hereby declare that to the best of my/our knowledge and belief the information furnished herein is true and complete.
Signature(s) of the applicant(s)
Place:
Date:
Strike out whichever is not applicable.