Form XXIX

(See Rule - 54,58)

Notice of occupation for Registration and grant or Renewal of License

Written notice prescribed under Sections 79,Rule 54 and Rule 58

LICENSE NUMBER………………………………………………………………………

:

1. Full name of the factory and its license number,

if already registered

:

2. (a) Postal address and situation of the

factory including the police station, tehsil

and district with PIN code.

(b) Address to which communication Relating

to the factory should be sent

(c) Contact Number of Factory

(d) Email Address of Factory

3. Nature of manufacturing process/ processes. :

:

(a) carried on in the factory during the next

twelve months (in case of factories already

in existence).

(b) to be carried o in the factory during the

next twelve months (in case of all

factories).

(c) Details of National Industrial Classification-

2008 (NIC) code.

(i) sub-class( 6 digit)-

(ii) description as per NIC

:

4. Names and values of the principal products

manufactured during the last twelve months.

:

5. (a) Maximum number of workers

proposed to be employed on any one day

during the year.

:

(b) Maximum number of workers employed in

any day during the last twelve months

(c) Number of workers to be employed in the

Factory

:

6. (a) Nature and total amount of power

(KW.)installed or proposed to be installed

(b) Maximum amount of power (kW) proposed

to be used

NOTE.—If power is not proposed to be used originally but is introduced later, the fact should be

immediately communicated to the Chief Inspector-cum-Facilitator.

:

7. In the case of a factory constructed or extended

after the date of the commencement of the rule

:

(i) 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-cum-facilitator.

(ii) 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.

:

8. Full name, father's name and residential

address of-

:

(i) The person who shall be Manager of the

factory for the purposes of the code

(ii) The occupier of the factory —

(a) The Proprietor of the factory if it is a

private firm or proprietary concern

(b) The Directors of the factory if it is a

limited company of firm

(c) Where Managing Agents have been

appointed, the name of Managing

Agents and their Directors

(d) Share-holders in case of a private

company where no Managing

Agents have been appointed.

(e) The Chief Administrative Head of

the factory if it is owned by

Government or a public authority

9. If the factory is covered by the provisions of :

Section 80 of the Code, full name, father's

name, and address of the owner of the

premises or buildings in which the factory is

situated.

10. Half Yearly(if applicable)& Annual return :

submitted (Yes / No).

11. Date on which the Manager assumed charge :

12. Date on which the occupier occupied the :

premises or will occupy the premises.

13. Detail of fee:- :

Amount of fee in Rupees paid through Bank /

E-Challan/Electronically or otherwise, reference

number and date.

14. Last annual return submission date :

15. Validity of No objection certificate for premises :

from state Fire control services-

I/We certify that information given by me/us is true and correct to the best of my/our knowledge.

Full signature of occupier………………..

Full signature of manager………………..

Full signature of owner, if any…………..

Date

Notes.

(1) This form should be completed in ink in block letters or typed.

(2) If any of the persons named against the item is minor the fact should be clearly stated.

(3) In the case of a factory where a Managing Agent or Agents have been appointed as occupiers

under the Indian Companies Act, 1913 (VII of 1913), information required in the item should be

supplied in respect of that person or persons.