Application Form for Electric Contractor License Category "B"

FORM “B”APPLICATION FOR ELECTRICAL CONTRACTOR LICENSECATEGORY “B”.1. Name & Address of the company: ________________________________________________________________________________________________________________________2. Description of the Registered Office. ______________________________________________________________________________________________________________________3. Nature of business __________________________________________________________4. Name, Designation & NIC No. of the person/Director authorized to sign documents ___________________________________________________________________________________________________________________________________ (Attach Attested copy of NIC)5. Financial Position supported by Bank Statement for the preceding year _________________6. National Tax Number (NTN). _______________________________ (Attach Attested Copy).7. Registration No. of the Firm from Registrar of the Firmst. _________ (Attach Attested Copy).8. Registration No. with General Sales Tax._________________ (Attach Attested Copy).9. Detail of previous Contractor’s License if held _________________ (Attach Attested Copy).10. Names, Academic & Technical Qualification of the Director/Partners. (Attach Attested Copy).11. Name of holder of certificate of competency on the strength of whose the contractors Licenseis being sort _______________________________________________________________12. Particulars of Testing Instruments (Complete Annex. ‘B-1’ & attach original purchase receipts).13. Detail of staff employed (Complete Annex. ‘B-1’ & attach attested copies of certificates and NIC)14. Fee Rs. 2000/-paid into NBP ___________Branch /vide treasury receipt No. __________Dated __________ (Attach original copy).I/We _____________________________________________________ hereby declare that:-i) Particulars stated above and filed in the Annex ‘B-1’ are correct to the best of my/our knowledge.ii) I/We fully understand the terms and conditions under which licence is granted (attach duly signedcopy of terms and condition).iii) I/We shall submit work commencement and completion reports on the prescribed proforma.iv) I/We shall supply regular return on any change occurred in the above particulars.iii) I/We shall comply with the instruction issued by Electric Inspector for the compliance ofprovisions of Electricity Act, 1910 and Electricity Rules, 1937.Dated: _____________________Signature: _________________________(Official seal of Company)...................................................................................................................................................................(For Official Use Only)Instrument Inspected by:Name/Designation _________________________Signature: _______________________________Documents checked by:Name/Designation: ________________________Signature: _______________________________Page 1 of 3

PARTICULARS OF TESTING INSTRUMENTSAnnex: ‘B-1’1. Megger (1000 V): Make: ____________________________Maker’s No: _______________________Range: ___________________________2. Megger (500 V): Make: ____________________________Maker’s No: _______________________Range: ___________________________3. Earth Tester: Make: ____________________________Maker’s No: _______________________Range: ___________________________4. Clamp on Meter: Make: ____________________________Maker’s No: _______________________Range: ___________________________5. Safety Gloves Make: ____________________________6. Helmet Make: ____________________________PARTICULARS OF THE TECHNICAL STAFF EMPLOYEDENGINEERS:1. a) Name:____________________________________ Father’s Name:_________________b) Qualification:_________________________________________(Attach Attested Copies)c) Certificate of Competency No. (‘B’ Category): _____________ (Attach Attested Copies)d) Membership No. of Engineering Council:_______________________ (Attach AttestedCopies)Diploma Holders1. a) Name:________________________________ Father’s Name:_____________________b) Qualification: _______________________ (Attach Attested Copies of Diploma and Certificate of Competency)Electrical/Wiremen:1. a) Name:________________________________ Father’s Name:_____________________b) Qualification: __________________________ (Attach Attested Copies of Permit)c) Certificate of Employment _____________________________________ (Attach copy)2. a) Name:________________________________ Father’s Name:_____________________b) Qualification: __________________________ (Attach Attested Copies of Permit)c) Certificate of Employment _____________________________________ (Attach copy)Dated:____________________________Signature of Authorized Person/DirectorPage 2 of 3

TERMS AND CONDITIONS FOR CATEGORY “B” LICENSEPage 3 of 3