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 :

1. This Form should be completed in legible ink in Block letters or typed Note : 
2. 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. 
3. If any of the person named at column No. 8 is a minor, deaf and dumb, the fact should be clearly stated. 
4. 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.