FORM I
BUREAU OF INDIAN STANDARDS
APPLICATION FOR GRANT OF LICENCE TO JEWELLER
FOR SALE OF HALLMARKED ARTICLES
(strike off whichever is not applicable)
1. Name and style of :
Sales Outlet (in full)
2. (a) Postal Address of Outlet : with Pin Code, District and State
Tel : Fax : E mail:
(With STD Code) (With STD Code)
(b) Location along with Landmark :
(please enclose location map)
3. (a) Type of Ownership:
(please refer to serial no. 1 of Proprietorship / Partnership / Limited Company / PSU the
list of documents enclosed)
4. Details of Management:
Name Designation
(Proprietor/Partner/Director/CEO) i) ii) iii)
iv)
5. Details of Contact Person:
Name: Mobile: e-mail:
6. Licence applied for: Gold Jewellery/artifacts OR Silver Jewellery/artifacts
as per IS 1417:2016 as per IS 2112 :2014
7. (a) Any other BIS Licence held: Yes / No
(b) If yes, give details: Licence No: Product: IS No.:
8. Details of Previous Cancellation/Convictions, if any, :
under The Bureau of Indian Standards Act, 1986
9. Details of Payment: Demand draft / Net Banking / Bank Challan
(please refer to the fees applicable for jewellers)
Amount Name of Bank Demand draft No. /UTR No. / Date
(in Rs.) Bank Challan No.
Signature :
(Proprietor/Partner/Director)
Name :
Designation :
Seal of Firm :
Date:
Place: