Dibrugarh Municipal Board
Vendor Registration Form
Name of street vendor
*
Father/Spouse Name
*
Mobile Number
*
Date of Birth
*
Gender
*
Please select
Male
Female
Transgender
Social Category
*
Please select
General
SC
ST
OBC
Martial Status
*
Please select
Single
Married
Separated
Religion
*
Please select
Hinduism
Buddhism
Christianity
Islam
Sikhism
Jainism
Others
KYC Details
Aadhar Number
*
PAN
*
Voter ID Number
*
Permanent Address
House No/ Locality
*
Ward/ Village
*
Town/ District
*
Pin Code
*
Current Address
Housr No/ Locality
*
Ward/ Village
*
Town/ District
*
Pin Code
*
Check if same as above
Booth Centre Details
Booth Centre Name
*
Booth Centre Number
*
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Do you have a family?
*
Family means husband, wife and unmarried children
Yes
No
If yes, then please provide total No. of family members
*
Total Monthly Family Income
*
(₹)
Add Family Details
Name of family member
*
Relationship with the applicant
*
Age
*
Gender
*
Male
Female
Transgender
+ Add more member
Vending Activity
*
Name of activity (Please Select)
Beauty & Fashion Accessories
Cloth & Handloom Items
Electrical & Electronic Goods
Fast Food & Food Items
Flower & Pooja Items
Footwear & Leather Products
Fruits & Vegetables
Home Decor & Handicrafts
Kitchen Items
Others (Please Specify)
Vending Since
*
Locality of Vending
*
Select Locality
R.K.B Path
Khaliamari
L.G Bordoloi Avenue
AMC Road
Area of Vending
*
Select Area
Adjacent to Post Office
Near R.K.B Law College
Opposite Bata Showroom
Opposite JJ Memorial Hospital
Opposite Radha Krishna Mandir
Upload photo of your Stall/ Cart
*
Ticket Number (if available)
Dimension of Stall/ Cart
*
Measurement in feet
Select preferred cart size
&& count($area_dimmenssion_master) > 0)
5*5 sq ft
5*6 sq ft
5*8 sq ft
Upload Your Photo
*
Declaration and Authorization:
This is only an application form for applying street vendor license for the stall to be installed at the vending zone and the decision shall be made by the Dibrugarh Municipal Authority after proper verification of all documentation and considering the place & nature of business at the vending zone and the decision made by the Dibrugarh Municipal Authority shall be final and binding.
All information provided in the Application Form must be accurate and complete.
Approval of this application does not guarantee a permit or license.
A registration fees of Rs. 100 /- to be paid along with the submitted registration form. Registration will only be considered complete upon successful payment of registration fees (to be paid offline at the DMB office).
The registration fees paid are non-refundable under any circumstances.
Once the registration fees are paid, no refunds will be provided, regardless of the reason for cancellation or rejection.
By submitting this Application Form, you acknowledge that you have read, understood, and agree to abide by these terms and conditions.
I hereby authorize the above
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