89 1 [GOVERNMENT OF WEST BENGAL FORM C3 Application Form for change of ownership nature of FPS from Individual to partnership/ from partnership to individual /induction or substitution of partner along with Checklist [Vide clause 20(vii) of the WBPDS (M&C) Order, 2013) 1. Please select the change of ownership nature (please tick in the appropriate box (√): a) Individual to Partnership firm due to incapacitation/ : death b) Induction of a new partner : c) Substitute the name of an existing partner : d) Reconstitution of firm by inducting family member : of the deceased partner (Where partnership firm only comprised two partners) e) Change of nature from partnership to individual : (Where no eligible person found in the family of deceased partner) 2. Comparative view of constitutions of previous entity running Dealership and the reconstituted entity Constitution of Previous Entity Constitution of the Reconstituted Entity i. Name of Proprietor/Partner-1 Name of Proprietor/Partner-1 ii. Name of Partner- 2 Name of Partner-2 iii. Name of Partner-3 Name of Partner-3 iv. Name of Partner-4 Name of Partner-4 (add row if required) 3. Name of the Applicant [Incapacitated dealer in : case of 1(a)/one of the legal heirs of the deceased dealer in case of 1(a)/Partnership firm in case of 1(b-d)/surviving partner in case of 1(e) of FPS] (In Block letters) 4. Father's/husband's name in case of dealer or : legal heir or surviving partner 5. Name of FPS (For which change of nature is : sought by the applicant) 6. Whether the same name & style would be : continued in reconstituted Dealership 7. If not, the name of the reconstituted firm/entity : 1 Forms C3 ins. by cl. (4) of the Notification No. 2596-FS/Sectt/Food/4P-09/2012 (Pt. II), dated 9th August, 2021 (w.e.f.9.8.2021).