Company Information
Name of Owner or Name of Company, if different from Applicant:
Registration No. of Company:
Address of Owner or Registered Office of Company:
Name of Directors:
Name of Chief Executive Officer/Equivalent:
Name of Marketing Manager/Equivalent:
Year Business Commenced:
Declarations
If the Applicant is an individual, have you been convicted of an offence involving fraud, dishonesty or moral turpitude or an offence under the Dangerous Drugs Act (other than an offence which attracts a sentence of imprisonment of not more than five (5) years) during the period of three (3) years immediately preceding this application OR any offence under the Jamaica Agricultural Commodities Regulatory Authority (JACRA) Act or Regulations under the JACRA Act?
No Yes
If the applicant is an individual, state whether you are an undischarged bankrupt?
No Yes
If the applicant is a body corporate, has any of its directors, managers, secretaries or such other officers been convicted of an offence involving fraud, dishonesty or moral turpitude or an offence under the Dangerous Drugs Act (other than an offence which attracts a sentence of imprisonment of not more than five (5) years) during the period of three (3) years immediately preceding this application OR any offence under the JACRA Act or Regulations under the JACRA Act?
No Yes
If the applicant is a body corporate, state whether any resolution has been passed for the voluntary winding up of the company or an order for the winding up of the company made by a Court?
No Yes
If the applicant is a body corporate, state whether a receiver or trustee has been appointed to manage the affairs of the assets of the company.
No Yes
If the applicant is a body corporate, state whether the company has notified JACRA of the readiness and suitability of its premises or business in relation to this application.
No Yes
List of documents attached in support of this application:
Statement by Applicant
I accept the Terms in the Statement below. I/We hereby certify that the information contained in this application and any document submitted to the Authority, are true and completed to the best of my/our knowledge and belief.
I/We understand that any misrepresentation contained in the form shall lead to discontinuation of the processing of the application and the revocation of any licence granted and may also lead to prosecution. I/We further understand that the licence, if granted, may be suspended or revoked for breach of any of the terms or conditions stipulated therein.
