Form 47

{see sub-rule (2) of rule 119 and rule 122}

Notice of occupation

LICENCE NUMBER………………………

For the year…………

01-Full name of the factory and its licence number, ……………………………..

02- (a) Address and situation of the factory including the police station, tehsil and district……..

(b) Correspondence Address …………………………………………………………………..

(c) Contact Number and Email Address of Factory……………………………………………

03-Nature of manufacturing process/ processes carried on in the factory during the next twelve

months…………..

04-Names and values of the principal products manufactured during the last twelve

months…………………..

05-(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) Actual number of workers employed in the Factory at present

……………………………………………

06-(a) Nature and total amount of power (H.P.)installed

………………………..………………………………

(b) Maximum amount of power (H.P.) ……………………………………………………………………….

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 or Licencing Authority.

07-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

08-Full name, father's name and residential address of.-

(i) The person who shall be Manager of the factory for the purposes of the

Act………………………………….

(ii)The occupier of the factory —

………………………………………………………………………………….09- 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- 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……………………………….

I hereby declare that our factory is complying / will comply with all health and safety provisions of The

Code 2020 to the best of my knowledge.

Full signature of occupier…………………………

Full signature of manager……………………………

Date