FORM No. 2
[See Rule 4 (1), 7(2) and 12]
APPLICATION FOR REGISTRATION AND GRANT OF LICENSE, RENEWAL OF LICENCE AND NOTICE OF OCCUPATION SPECIFIED IN SECTIONS 6 & 7 (TO BE SUBMITTED IN TRIPLICATE) FOR
YEAR/YEARS . . . . . . . . . . . . FACTORY LICENCE NO. . . .. . . . . . . . . .1. Full name of the factory : _________________ ____
2. (a)Full postal address and situation _________________ ____
of the factory : _________________ ____
Phone No ____________
(b)Full address to which communication: _________________ ____
relating to the factory should be sent
3. Nature of manufacturing process/processes
(a)carried on in the factory during the: _________________ ____
last twelve months(in case of factories
already in existence)
(b)to be carried in the factory during : _________________ ____
the next twelve months (in case of all factories)
4. Names and values of the products manufactured during the lest
twelve months : _________________ ____
(in case of factories already in existence)
5. (i) Maximum number of workers proposed : _________________ ____
to be Men Women employed on any one
day during the year, applied for
(ii) Maximum number of workers employed : _________________ ____
on Men Women: Men Women any one day during the last twelve
months (in case of factories already in existence)
(iii) Number of workers to be ordinarily : _________________ ____
employed in the factory
6. (a) Nature and Total amount of power installed (H.P.of motors)
(i) Installed : _________________ ____
(ii) Proposed to be installed : _________________ ____
(b) K.W. of Electric Factories or : _________________ ____
attached Power Houses or Heating
Circuits.
7. Full name & residential address of the : _________________ ____
person who shall be the Manager of the
factory for the purpose of the Act
8. Full name and residential address of : _________________ ____
the Occupier i.e. :
(i) The Proprietor of the Factory in : _________________ ____
case of the Private Firm /
Proprietary] concern
(ii) Any one of the individual partner/ : _________________ ____
name and residential address of
Other partners.
(iii) The Director in case of a Public : _________________ ____
Limited Company or Firm
(iv) The Managing Director and Directors:
of a Private Company
(v) In case of factories owned or : _________________ ____
controlled by the Central Government/
State Government or any Local Authority, the person or
persons appointed to manage the affairs of the factory
by the Central Government, the State Government or the
Local Authority as the case may be (The appointment order
of such person or occupier shall be enclosed)
9. Full name & address of the owner of the : _________________ ____
premises or building (Including the
precincts thereof referred to in Section 93)
10. In case of a factory constructed or : _________________ ____
extended, after the date of the commencement of these rules
(i) Reference number and date of approval : ______________
of the plans for site, for old or new
buildings and for construction or extension of factory
by the Chief Inspector ; and ,
(ii) Reference number and date of the : ______________
arrangements, if any, made for disposal
of trade waste & effluents and the name
of the authority granting such approval,
copy of certificate to be enclosed.
11. Amount of fee Rs______________ (Rupees . . . . . . . . . . .
. . . . . . . . . . .....) paid into the ___________________
Treasury/Bank on .……………….. vide Challan/D.D/Cheque No.………………
(enclosed)
(SIGNATURE OF THE OCCUPIER) (SIGNATURE OF THE MANAGER)
(NAME IN BLOCK LETTERS) (NAME IN BLOCK LETTERS)
Date: ………………………… Date. …………………………
Note :
- This Form should be completed in legible ink in Block letters or typed Note :
- If power is not used at the time of filling up this Form, but is introduced later, the facts should be communicated to the Inspector of Factories and Chief Inspector immediately.
- If any of the person named at column No. 8 is a minor, deaf and dumb, the fact should be clearly stated.
- In case the column No. 8 is inadequate to fill in the required information, a separate sheet shall be appended to the same which should be attested by the Occupier.