FORM 1
(see rules 3,5, 8, 11 and 14)
Application for permission to construct a new factory, to extend existing factory or take into use any
building as a factory/ Application for Registration and Notice of occupation specified in sections 6 and 7
and for Grant of licence* / Renewal of licence* of a factory
(*Mark which is applicable)
1. Full name and address of factory
Telephone Number
Fax Number /
E-Mail
2. If already registered, month and year of registration
3. Licence number, if granted
4. Reference number and date of latest approval of the
plans by the State Government / Chief Inspector of
Factories / Joint Chief Inspector of Factories /
Deputy Chief Inspector of Factories.
5. A flow chart of the manufacturing process
supplemented by a brief description of the process in
its various stages, list of the raw materials used,
intermediate products, including emission of toxic
gases, etc., finished products by-products, their
quantities, methods of storage and handling, loading
and transport and details of the arrangements for the
disposal of trade waste and effluents, the likely
hazards and the method to control or eliminate them.
(Attach separate sheet if required)
6. Particulars of plants to be installed
7. The period for which licence or renewal of
licence is applied for (not exceeding ten years )
8. Maximum number of workers to be employed on Male Female Total
any one day during the year
9. Installed power in H.P.
10. Full name and
residential address of Occupier
Director/Partner / Proprietor
Date of Birth
Nationality
Mobile No. and E-mail
Signature of Occupier
11. Full name and
residential address of
Manager
Date of Birth
Nationality
Mobile No. and E-mail
Signature of Manager