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O D I S H A
* * * * * * *
Name of the Person/Firm :
Amount deposited :
Challan No. & Date :
Sl.No.
Signature of Issuing Authority
FORM B
(REGULATION-27)
APPLICATION FOR ELECTRICAL CONTRACTORS LICENCE
1. Name (In block letters) in which :
The License is required
2. Business Address :
3. Full Name & Address of Proprietor/ :
Managing Partner/Director
Authorized representative.
4. Category of work for which :
Permanent License is required
Contd.P/2.
-:2:-
5. Details of work project for which :
License/Extension is required.
6. Period for which temporary :
License/Extension is required
7. If a contractors license (permanent :
or temporary) was previously issued in the
Same name details to be furnished.
8. Names of Supervisors & Electrical : 1.
Workman to be engaged to be mentioned
2.
(The Ref.No.of S.C.C. and Workmans
Permits to be furnished), 3.
4.
5.
9. Particulars of Testing Equipments :
available.
10. Details of :
(i) Treasury Challan enclosed :
(ii) Income Tax Clearance Certificate :
and VAT Clearance Certificate.
11. Compliance of other requirement specified :
by the Government.
We hereby declare that the particulars stated above are correct to the best of
my/our knowledge and belief.
Place : SIGNATURE
Date :
DESIGNATION