ANNEXURE-V

SCHEDULE   

FORM OF DECLARATION.

FORM-I

 

 

              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.

(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.

3. Retail selling price of the news papers.

If the newspaper is for free distribution , please state that it if for free distribution.

(b) If it has only an annual subscriber please state the annual subscription.

4. Publisher’s Name:-

Nationality.

Address:

5. Place of publication 

6. Printer’s Name.

Nationality.

Address:

7. Name  of the printing press where is to be conducted  and the true and precise description of the premises of which the press is/are installed.

8. Editor’s Name

Nationality.

 Address.

9.. Owner’s Name(s)

a) Please state is the particulars of individuals or of the firm, company, trust cooperative society or association. 

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

10. 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.

 

 

 

Date                                                Designation Printer/Publisher/Editor.