FORM 2
(Prescribed under Rule 4 and 12)
Application for Registration and Grant of Amendment of Licence And notice of occupation
(To be submitted in triplicate)
1. Application for
(a) Registration,
grant of
licence Yes/No
and notice of
occupation
(b) Amendment of
licence Yes/No
2. (a) Applicants name
(b) (i) Whether factory already
registered Yes/No
(ii) If Yes, Registration No.
(iii) Licence No.
3. Full name and postal
address of the factory
(a) Name of the factory
(b) Address
(Town/Village/District/Pin Code No.)
Please indicate following details also
4. (a) Nearest Police
Station distance
(b) Nearest Railway Station distance
(c) Nearest Public Hospital distance
5. Full name and
residential address of the
person who shall be the Manager of the
factory for the purpose of the Act.
6. Full name and
residential address of the
occupier and his designation e.g. Director,
Partner, Proprietor
Or
(d) Any other (specify)
7. Full name and address
of the owner of the
premises of building (including the precints
thereof) referred to in Section 93.
8. Please furnish reference number (s) of
and Authority Details
date(s) of approvals (s) of the plans of site (i)State Govt.
and building and for disposal or trade wastes
(ii)Local
Authority
and effluents by the concerned authorities (iii)Chief Inspector
(iv)Pollution
Control
Board
(v)Other concerned
authority
(specify)
9. (a) Nature of manufacturing processes to be
carried out in the factory List of process
(b) In case of application for amendment,
List of process
indicate manufacturing processes carried
out previously
10. Names and quantities of raw materials
used, Name Quantity
intermediate products and principal finished
(Vol.Wt/No)
products during the last twelve months
(in case of factories already in existence)
11.Number of workers employed in the factory Employed in the last Proposed to be
12 months employed in next12months
(a) Maximum Number
(b) Number ordinarily employed
12. Nature and total amount of power
(In Kilowatts)
(a) Installed
(b) Proposed to be installed
13. Fees paid (Details) Rs. ... (in figures)
.
. (in words)
Vide Treasury Chelan/Postal Order/ Bank
draft/ Cheque No.
.
date
drawn on
..
Date : 1. Signature of the Manager
Date : 2. Signature of the occupier
Notes: 1. This form should be completed in ink in block letters or typed.
2. Strike off whichever is not applicable.
3. If power is not used at the time of filling up this form, but introduced later, the fact should be communicated to the Chief Inspector of Factories, immediately.
4. The term Ordinarily employed would mean the total number of workers working in all the shifts which should be over 50% of the working days in the factory.