Form 7

(see rule 8(4))

Application for factories involving non-hazardous process and employing up to 50 workers

I____________________________________ S/o_____________________________ R/o _____________________________________

_________________________and Occupier of M/s______________________________ ________________ hereby state as

under-

1. That I have applied for registration of my factory in the name of M/s ___________________

__________________ situated at (Complete address of the factory) ____________________________

2. That I have gone through the Code & rules and regulations made thereunder and have fully

understood the contents of the Code & Rules and undertake to abide by the same.

3. That I propose to employ up to 50 workers.

4. That I shall inform and submit relevant necessary documents as per Code and Rules, in case of:

i. change of building & machinery layout;

ii. change in manufacturing process;

iii. addition of any manufacturing process involving hazardous process or dangerous process Major

Accident Hazards (MAH) Installation; or

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iv. employment of more than 50 workers.

5. NOTE - Seal bearing “Authorised Signatory shall not be used.

Place:

Date:

e-sign/Signature of occupier with seal:

(Name of occupier)

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:

e-sign/Signature of occupier with seal:

(Name of occupier)