(See rule 11) 1. Name of applicant (person or firm). 2. Address of applicant (person or firm). 3. Identification and description of object with three copies of photographs in postcard or quarter size. 4. Material. 5. Size. 6. Approximate date. 7. Source of acquisition. 8. Where the applicant has come into ownership, control or possession of any antiquity which is already registered under the Act, registration number oi such antiquity and the name of registering officer, who had registered it. 9. Date of acquisition. 10. Mode of acquisition. 11. Price paid if any. 12. Present location and (b) Condition of preservation and securitv. 13. If the antiquity is already registered under the Act, whether its registration certificate has been attached. I declare that the above information is correct and complete to the best of my knowledge and belief. I also undertake to observe the provisions of the Antiquities and Art Treasures Act, 1972, and the rules made thereunder. Seal of the Organization Place Signature Date Name of the applicant 1. If the application is on behalf of an organization, the name thereof should be given. 2. If the application is on behalf of an organization, the signature should be that of the head of that organization.
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