Issue to M/S / Sh...........................................

WC-............
For Chief Electrical
Inspector

FORM F
GOVERNMENT OF HIMACHAL PRADESH
Application for C Class Electrical Contractors License(To be filled in English or
Hindi )
1. Full name and address of the applicant/
firm.....................................
.............................................
................
...............................................................
.
2. Name of partners, if any................................................

......................................................
............
3. Details of contractor license previously granted ....................................
..
................................................
..............
4. Details of certificate held by the applicant/or
partner................................
..............................................................
.
5. Name and certificate No. of holder or certificate of competency as Electrical
Supervisor

(No..)/

Wireman

Permit(No)

of

Electrical

Inspectorate of H.P. and /or Degree/Diploma/Certificate in Electrical Engineering

from .. (Name of the Institution), which is recognised

by the

Central Govt. State Govt. on the strength of which the Contractors

License is sought.
6. Amount of fees deposited Rs. 2500/- for five years (as applicable) Treasury Challan
NoDate..Name

of

treasury...

7. Three passport size photographs duly attested on reverse by a competent

authority/Gazetted Officer should be sent alongwith application form.
I/We

..

...................................................
hereby declare that the particulars stated above are correct to the best of my/our
knowledge and that I /We fully understand the terms and conditions under which a

contractors license is granted and that a breach of them will render the license liable
to suspension or cancellation.

Dated.20

Signature of applicant,

Signature of partner.
Note:- Strike-out whichever is not applicable.

Last date for Submission:

10/01/2012

GOVERNMENT OF HIMACHAL PRADESH

Annexure I
APPLICATION FORM FOR ENLISTMENT AS AN ELECTRICAL
CONTRACTOR FOR CLASS C
1

Full Name (in Block Letters) .........................................

(Photo attested by a
Gazetted officer)

Fathers Name

Contact No.
a. Landline No. with code:b. Mobile No.:c. Fax No.:Permanent Address

...........................................

..
....
.
...............................................................
...............................................................

Address for Correspondence

...............................................................
...............................................................
...............................................................

Cost of Application Form

( copy of Original Challan to be enclosed)

...............................................................
Original Challan No. ...
Dated

10

Date of Birth(Authentic proof of age is to be

supplied)
Details of Academic Qualification
(Attested copy to be supplied)
Details of Technical Qualification
(Attested copy to be supplied)
a. Bachelor Degree in Electrical
Engineering
b. Three Year Diploma in Electrical
Engineering
(with one year experience after passing
Diploma)
c. Retd. Assistant Engineer having served as
an Assistant Engineer at least for 5 years
(superannuation proof attached)
If presently held any Class of License

11

(Attested copy to be supplied)

Class in which enlistment sought

8
9

12

Whether the applicant has necessary

instruments, tools and Books as required
under rules of Licensing Board along with
original cash vouchers of instruments
purchased/held. The detail information may
please be supplied on Annexure I(a).

13

Detail of Staff (The detail of staff information

may please be supplied on ANNEXURE I(b))
A) Name of Wiremen
a.i) If Self employed
(Yes / No)
ii) Experience
(Attested copy to be attached)

..

...........................................................
............................................................
.............................................................
.
.

License No............................................
(Copy enclosed)
..
Whether Yes / No

1.Name.........................................
Permit No..................................
Period of validity...

b i) If Engaged
(Yes / No)
ii) Experience
(Attested copy to be attached)

2. Name..........................................
Permit No...................................
Period of validity.

14

Whether the Affidavit of employee as per

specimen Annexure II & III is supplied.

Yes / No

15

Whether the Affidavit of employer as per

specimen Annexure IV is supplied.

Yes / No

15

Whether the Affidavit of the Immoveable

property as per specimen Annexure V is
supplied.

Yes / No

16

i)

In case of Firm/Company/Society,
submit attested copy of Registration.
ii) The power of attorney to whom the
Firm has given signatory Authority to
sign the License papers in the
jurisdiction of Himachal Pradesh with
the proof on Indian Nationality.

Yes / No

17

Original Character Verification Certificate as

per specimen enclosed (see Annexure V)

Yes / No

18

Whether the contractor has read the Rules

for enlistment of contractor and is prepared
to abide by them.

Yes /

19

Whether three recent passport size

photographs out of which photograph to be
got attested from the front to be attested by a
Gazetted officer of each individual contractor,
owner of the Firm and Supervisor is to be
supplied.
Whether attested three specimen signature by
the Gazetted officer of the below mentioned
is supplied:
i) Individual Contractor
ii) Person holding the Signatory Authority.
iii)Supervisor

No

Yes / No

Yes / No

CERTIFICATE
1. I/We certified that I/we will not myself/ourselves registered as contractor in the
department under more than one name.
2. I/we also certify that the proprietor/Director(s) are not dismissed/black list by
Government/Semi-Government servant.
3. I/we undertake not to employ directly or indirectly any person dismissed from
Government/Semi-Government device in or business without prior permission of
the office.
Dated
Signature of the
applicant:- ...
Full Address:.

Note:-

1. Eligibility:- C Class Electrical Contractors license will be granted to such persons who himself is a
licensed Wireman and have passed I.T.I. in Electrician/Wireman Trade and have one year experience
after getting Wireman Permit.

OR

To such person who himself is a licensed Wireman and have passed Matriculation Examination and
have two years experience after obtaining the wireman permit after qualifying the Wireman
examination.

2. The complete Application Form D and Annexure I to enlist the Contractor will be submitted along with
the 2 Nos. self stamped 2 envelops of

size 25x12 cm of `. 10/- each written with his full

correspondence address and Phone No./ Mobile No. with the STD Code.

3. The application found in order in all respect shall be called to attend the office of Licensing Boardcum- Chief Electrical Inspector, Block No. 239, SDA Complex, Kasumpti-171009(H.P.) on the fixed
day 21st , of January, 2012. The applicant must be ensured his presence alongwith employed staff to
attend this office on the fixed schedule to verify the instruments and Books with original cash memos
and original documents (ensure presence of Supervisors and Wiremen Permit Holders with there
original certificates and permits)..
4. The license fee of ``. 2500/- shall be charged from the applicants after the verification of Sr. No. 3 and
the eligible candidates documents shall be put up to the Licensing Board for approval please.

ANNEXURE-I(a)
Verification of instruments for the year........................................................................
Name of the Contractor.................................................................................................
Class of Contractor........................................................................................................
License No.....................................................................................................................

To be verified on dated: 21/01/2012

Description of Instruments:Sr.

Name of Instruments

Make

No.

Sr. No.

Range

of

Capaci

In working

Original Cash

ty

order/Defec

Book No. and

tive

date

Instrume

Remarks

nts
1

I.S.I. Approved Insulation Tester/ Megger of 500

Volts

One line Tester.

Name of Books:

I.S.: 732-1963 Code of practice for electrical

wiring installation (System Voltage not
exceeding 650 Volts)

I.S. 5216-1969 Guide for safety procedures in

Electricity Works.

Indian Electricity Rules, 1956 read with

Electricity Rules, 2005.

( Signature of the Contractor)

Date:
Checked by.................................................

Counter Signed by:-

Name and Designation................................

Chairman/ Secretary Licensing Board,

(Not below the rank of Assistant Electrical Inspector)

Block No. 29, SDA Complex, Kasumpti,

....................................................................

H.P. Shimla-171009

Date.............................Place.......................

ANNEXURE-I (b)
STAFF REGISTER TO BE MAINTAINED BY THE ELECTRICAL CONTRACTORS

To be verified on

Name of Contractor.....................................................License No............................

dated: 21/01/2012
Detail of Wireman Employed
Sr.
No

Name of
Wireman and
full address

Whether self or
employed

Wireman Permit
No.

Period of
validity

Date of
appointment

Gross monthly
Salary

Signature of
Wireman

Signature of
the
proprietor

Remarks

Detail of Apprentices

Sr.
No

Name of
Apprentices and
full address

Whether self or
employed

Apprentices
Certificate of
Competency No.

Period of
validity

Date of
appointment

Gross monthly
Salary

Signature of
Apprentices

Signature of
the
proprietor

Remarks

ANNEXURE- II
SPECIMEN OF AFFIDAVIT (from staff employed)
On Non-Judicial Paper worth Rs. 3/(To be verified and attested by competent authority i.e. Magistrate Ist Class)

_________________________Son

of

Shri

__________________________________________________
___________________________________Solemnly declare as under:That I

am technically qualified person

possessing

Wireman Permit

(WMNo._________) of Electrical Inspectorate of Himachal Pradesh.

That

am

working

under

________________________________________________

wiring contractor as a_________________________________________

That in the event of my accepting Government or other employment or leaving
the business of the above contractor/firm, I undertake to inform immediately the
Chief Electrical Inspector, Himachal Pradesh. In case of default, I shall be responsible
for consequences and of Government action.

Dated_________200

(Signature of applicant)
Name_______________
Address______________

I, the above named deponent do hereby affirm that the contents of my above
affidavit are true to the best of knowledge, no part of it is false and nothing has been
concealed there from.

Attested by:-

Deponent.

Annexure -V
AFFIDAVIT for immovable Property.
I, aged.Son of Sh.
do hereby solemnly affirm and state on oath as under:-

1.

That I am owner and in possession of land and house situated in

the value of my above

mentioned property is more than ..
2.

That my above mentioned property is free from all circumstances.

3.

That if my name is enlisted as contractor with the department in that event my

above mentioned property shall remains with the department as security.

4.

That if any loss caused to me in any Government contractor ship work in that

event the department has full right to recover the said amount from my property.

Deponent.

Verification:I, the above named deponent do hereby verify that the

content of this affidavit are true to the best of my knowledge
and belief. Verified on ..

Deponent.

CHARACTER CERTIFICATE
(Specimen)

No..
From:.

It

Valid

is

certified

that

Sh.
S/o

Sh.

.resident
Village

Post

of

Office.Teh.

Distt.(H.P.) bears good moral character

as per report of

Pradhan, Gram Panchayat:

SHO, Police Station

: .

Place

:.

Date :

Executive
Magistrate