SCHEDULE (ANNEXURE-I)

FORM OF DECLARATION.

FORM-I

(See Rule-3)

              I Sri /Smt......……………........ declare that I am the printer or publisher and publisher of newspaper entitled…........to be printed at.................... and published at .............and that particulars in respect of the said newspaper given here under are true to the best of my knowledge and belief.

1. Title of the newspaper:-

2. Language(s) in which it is (to be) published.

3. Periodicity of its publication.

(a) Whether a daily, tri-weekly, I-weekly, weekly, fortnightly or otherwise

(b) In the case of a daily please state whether it is a morning or evening newspaper.

(c) In the case of a newspaper other than a daily, please state the days on which it is (to be) published.

4. Retail selling price of the news papers per copy.

5.  (a) If the newspaper is for free distribution , please state that it if for free distribution.

     (b) If it has only an annual subscription and no retail price ,please state the annual subscription.

6. Publisher’s Name:-

Nationality.

(a) Whether a citizen of India :

      a.  If a foreigner, state country of origin.

          Address.

7. Place of publication (please give the complete postal address).

8. Printer!s Name.

    Nationality.

(a) Whether a citizen of India.

(b) If a foreigner, state country of origin.

Address:

9. Name (s) of the printing press(es) whether printing is to be conducted and the true and precise description of the premises of which the press (es)is/are installed.

10. Editor’s Name

     Nationality.

(a) Whether citizen of India.

(b) If a foreigner, state of country of origin.

     Address.

11. Owner’s Name(s)

a) Please state is the particulars o9f individuals or of the firm joint stock company, trust cooperative society or association which owns the news paper.

(b) Please state in whether the owner owns any other news paper and if so, its name, periodicity, language and place of publication.

12. Please state whether the declaration is in respect of

(a) a newspaper, or

(b) an existing newspaper

a.      in case the declaration falls under item(b) the reason for filing the fresh declaration.

                                                                                                                Signature

Name in Block letters.

Designation.

• Strike out what ever is not applicable.

Note- Separate declaration sho9uld be filed by the printer and the publisher, unless the printer and publisher is the same person.

Authenticated by me on .. . . . ......................

(Signature and official seal of the D.M)

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