FORM I
FORM OF DECLARATION
(See Sec. 17-E and sub-section (2) of Sec. 44)

To
The Chief Wild life Warden,
State or Union Territory of ………..
1. Full name and address of the cultivator or dealer in specified plants, parts and derivatives thereof making declaration
2. Actual stock held on the date of declaration:

Name of the specified plant (including scientific name)	Known uses	Description of stock	Quantity held in stock kgs/ number	Premises where stocks are kept	Date of procu-rement	Source & specific area of procu-rement	Docu-mentary proof, if any
1	2	3	4	5	6	7	8

3. Remarks, if any ……………
I do hereby declare that the information given above is true to the best of my knowledge and belief.
Signature of the person
Making the declaration
Place:…………..