FORM No. 4
(Prescribed under Rule 5)

 Licence to work  a factory

 

Name of Industry.         :

Registration No.            :

Licence No.                  :

NIC Code Number       :

 

Licence is hereby granted to …………………………………….. for the premises known as ……………………………situated at……………………….
………………………………….. for use as a factory within  the limits stated herein after subject to provisions of the Factories Act, 1948 and the rules made thereunder for following manufacturing processes:

 

1. …………………………………………( NIG Code number for each process)

2.  …………………………………………

     The …………………………………………..19………. issuing authority

 Details or Licence

 

Valid for

Fee paid

Excise

Additional
Fee paid for late payment

Date of payment

Signature of the issuing authority

 

Calendar year

Maximum number of workers on any one day

Maximum installed power in kilowatts

Rs.

Rs

 

Granted under Rule 5

 

 

 

 

 

 

Renewed under Rule 7

 

 

 

 

 

 

 Transfers

To whom
transferred

Date of transfer

Transfer fee paid and date of payment

Signature of the
issuing authority

 

 

 

 

 

 

 Amendments

Date when
amended

Amended
workers

Installed
power in kilowatts

Amendment fee paid and date of payment

Additional fee paid and date of payment

Signature of the issuing authority