FORM No.
2
(See Rule 4, 5, 6, 7, 8)
Application for registration / renewal /amendment/transfer of licence andnotice of
occupation as specified in section 6 and 7
(To be submitted in triplicate)
1. Period of licence:
1. YEAR (s) for which licence is applied for From To
2. General Information:
2a. Full name of the factory
2b. Factory registration number RJ -
(if already registered )
3. Address and contact information:
3a. Full postal address along with pin code and
telephone Number of the factory
3b. Full postal address along with pin code for
communications (if differ from above)
4. Nature of manufacturing processes:
4a. Date of start of production (for registration)
4b. Manufacturing process carried on in the factory in
the last twelve months
4c. Manufacturing process to be carried on in the
factory during the next twelve months
4d. Details of product (s)manufactured during the last
twelve months
5. Workers employed:
5a. Maximum number of workers proposed to be Male Female Total
employed during the year
5b. Maximum number of workers employed during
the last twelve months on any day
5c. Number of workers ordinarily employed in the
factory
6. Power installed:
6a. Total rated horse power ( installed or to be
installed) (attach sanction load and first electricity
bill)
6b. Maximum amount of Power (H.P) proposed to be
used
7. Particulars of Factory Manager:
7. Name and address of the person who shall be the Name
Factory Manager (if appointed) of the factory for Residential
the purposes of the Act address
Contact No.
(if any)
8. Particulars of Occupier:
8a. Name and address of the occupier Name
(in case of a private firm.) Residential
Attach list of partners with complete details, (in Address
case of partnership firm) Contact No.
(if any)
8b. Name and address of the Director in case of a Name
private/ public limited company Residential
( attach list of Director with details) Address
Contact No.
(if any)
8c. Full name and residential address of the Managing Name
Agent in case where a managing agent is appointed Address
by the Central Government / State Government / Contact No.
Local authority as Occupier (if any)
9. Land & Building:
9a. Full name and address of the owner of the Name
premises or building (including the precincts Address
thereof) (referred to in section 93 of the Act) Contact No.
(if any)
9b. Reference number and date of approval of the plans
for site, whether for old or new building and for
construction or extension of factory by the State
Government / Chief Inspector
10. Disposal of wastes and effluents:
10. Reference number and date of approval of the
arrangements, if any made for the disposal of trade
waste and effluents and the name of the authority
granting such approval.
11. Fees Details:
11. Total amount of fees paid Rs.
11a. In case of payment in treasury Name of Bank
(Original Challan to be enclosed) & Branch
Challan
number
Date
11b. In case of payment by Demand Draft Name of Bank
(Demand Draft shall be in favour of the Chief
Inspector of Factories & Boilers, payable at Demand Draft
Jaipur ) number
Date of
Demand Draft
11c. In case of online payment, details thereof
12. NOTE
a. In case of any change in the above information, Department shall be informed in
writing.
b. Seal bearing “ authorized signatory “ shall not be used on any document.
Place:
Date:
Signature of Factory Manager with seal: ______
( Name)
Signature of occupier with seal:
( Name )
VERIFICATION
I the above named Occupier do hereby further solemnly affirm that the contents given
above are true to the best of my knowledge.
Place: __________________
Date: __________________
Signature of Occupier …………………………….…….
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CHECKLIST
NOTE: This application shall be accompanied by the following documents:-
1. This form should be completed in block letters or typed.
2. Every page of the form should be signed by the Occupier.
3. If power proposed is not used at the time of filling up this form, but is introduced later,
the fact should be communicated to the Chief Inspector of Factories and Boilers
immediately.
4. If any of the persons named against items 7(a) and 7(b) is minor, the fact should be
clearly stated along with documents.
5. Any correction made in the Form should be duly signed by the Occupier or the Factory
Manager.
6. List of documents to be enclosed :
(i) Latest List of partners / Latest List of Directors.
(ii) In case of change of Directors submit Form No. 32 of the Companies Act,
1956.
(iii) Partnership deed / Memorandum of Articles of Association.
(iv) Land ownership documents.
(v) RIICO lease deed .
(vi) Land use conversion document (in case land is not in RIICO industrial
area).
(vii) Rent deed / lease deed.
(viii) Load sanction copy & First electricity bill for registration.
(ix) latest electricity bill for renewal.
(x) Photo ID and address proof of the Occupier and the Factory Manager.
7. Every page of the Documents submitted along with the Form should be self
attested by the Occupier or the Factory Manager along with date.”
