Escolar Documentos
Profissional Documentos
Cultura Documentos
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
by the
of
treasury...
..
...................................................
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.
Fathers Name
Contact No.
a. Landline No. with code:b. Mobile No.:c. Fax No.:Permanent Address
...........................................
..
....
.
...............................................................
...............................................................
...............................................................
...............................................................
...............................................................
...............................................................
Original Challan No. ...
Dated
10
11
8
9
12
13
..
...........................................................
............................................................
.............................................................
.
.
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
Yes / No
15
Yes / No
15
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
Yes / No
18
Yes /
19
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
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.....................................................................................................................
Description of Instruments:Sr.
Name of Instruments
Make
No.
Sr. No.
Range
of
Capaci
In working
Original Cash
ty
order/Defec
tive
date
Instrume
Remarks
nts
1
Name of Books:
....................................................................
H.P. Shimla-171009
Date.............................Place.......................
ANNEXURE-I (b)
STAFF REGISTER TO BE MAINTAINED BY THE ELECTRICAL CONTRACTORS
To be verified on
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
possessing
Wireman Permit
am
working
under
________________________________________________
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.
3.
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.
Deponent.
CHARACTER CERTIFICATE
(Specimen)
No..
From:.
It
Valid
is
certified
that
Sh.
S/o
Sh.
.resident
Village
Post
of
Office.Teh.
: .
Place
:.
Date :
Executive
Magistrate