The Occupational Safety, Health and Working Conditions (Andhra Pradesh) Rules, 2026
Form XXIV
Official text
Open in the official PDF (pp. 482–484)
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(See Rule-118(2))
APPLICATION FOR GRANT/AMENDMENT/
TRANSFER OF FACTORY LICENCE
1. LIN/Registration No:
2. Full name of the factory:
3. Full Address and location of the site/factory:
4. Longitude and Latitude:
5. Nature of Manufacturing Process:
a) Main:
b) Secondary:
6. Reference by which plans approved by the Chief Inspector (if
applicable):
7. Maximum number of employees to be employed.
Male Female Total
(a) Adults
(b)
Adolescents
Grand Total
8. Ownership Type/Sector (Public / Private / Partnership) :
9. Activity as per National Industrial Classification:
10. NIC Code:
11. Identification of the Factory e-sign/ digital sign of the Occupier :
12. Details of Occupier:-
a. Name &Address of Occupier:
b. Father / Husband
c. Age:
d. Designation (Occupier shall be proprietor/partner/Director in
case of Company):
e. Email Address, Telephone& Mobile No:
13. Manager Details
a. Full name & Address of Manager
b. Father / Husband
c. Age:
d. Address of Manager:
e. Email Address, Telephone& Mobile No:
14. MAXIMUM HORSE POWER INSTALLED: HP/KW
15. STANDY / POWER GENERATION CAPACITY: KVA
16.Date of occupation of the factory by the occupier * (Note: Date
from which manufacturing activities commenced in factories)
1. Full name and residential address of the owner of the building
referred to insection 80of the Act, "Where separate buildings in the
same premises areleased to different occupiers of which the
applicant is one".
2. For how many years you want to pay the license fee: 1 to 10
3. Type of the factory: Hazardous/Non hazardous
Signature of Occupier Signature of Manager
Enclosures for factory licence:
1. Proposed Inventories of Chemicals Used and Stored as per Schedules 2
& 3 of MSIHC Rules 1989.
2. Latest List of Partners / Latest List of Directors:
3. Partnership Deed / Memorandum of Articles of Association:
4. Appointment letter as occupier in case of Government Factories
5. Land Ownership documents (Registered Sale Deed / Lease Deed)
6. Photo ID proof of the Occupier and the Factory Manager
7. Approval letter of Plans of the factory under the Code
8. Certificate of stability issued by a competent person
9. Board resolution copy.