FORM C

APPLICATION FOR ELECTRICAL CONTRACTOR LICENSE

CATEGORY C.
1.
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Name & Address of the Applicant ______________________________________________

__________________________________________________________________________
Description of the Commercial Premises. _________________________________________
Nature of business __________________________________________________________
Name, Designation & NIC No. of the applicant/partners authorized to sign
documents__________________________________________________________________
_____________________________________________________ (attach attested copy of NIC)
Financial Position supported by Bank Statement for the preceding year _________________
National Tax Number (NTN). ________________________________ (attach attested Copy).
Detail of previous Contractors License if held ____________________________________
Names, Academic & Technical Qualification of the Applicant/Partners.(Attach separate sheet).
Name of holder of Certificate of Competency on the strength of whose the contractors License
is being sort _______________________________________________________________
Particulars of Testing Instruments (Complete Annex. C-1 & attach original purchase receipts).
Detail of staff employed (Complete Annex. C-1 & attach attested copies of certificates and NIC)

Fee Rs. 1000/-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 C-1 is correct to the best of my/our knowledge.
ii) I/We fully understand the terms and conditions under which license is granted (attach duly signed
copy of terms and conditions).
iii) I/We shall submit works 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 of
provisions of Electricity Act, 1910 and Electricity Rules, 1937.

Dated: _____________________

Signature: _________________________
(Official seal of the Company)

...................................................................................................................................................................
(For Official Use Only)

Instruments Inspected by:

Name/Designation _________________________
Signature: _______________________________

Documents checked by:

Name/Designation: ________________________
Signature: _______________________________

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Annex: C-1

PARTICULARS OF TESTING INSTRUMENTS

(I).

Megger (1000 V):

Make: ____________________________
Makers No: _______________________
Range: ___________________________

(II).

Earth Tester:

Make: ____________________________
Makers No: _______________________
Range: ___________________________

(III).

Clamp on Meter:

Make: ____________________________
Makers No: _______________________
Range: ___________________________

(IV).

Safety Gloves

Make: ____________________________

(V).

Helmet

Make: ____________________________

PARTICULARS OF THE TECHNICAL STAFF EMPLOYED

DIPLOMA HOLDER:
1.

a) Name:____________________________________ Fathers Name:_________________

b) Qualification:______________________ (attach attested Copies of diploma and certificate of competency)
c) Certificate of employment ______________________________________ (Attach Copies)

ELECTRICIAN/WIREMAN
1.

a) Name:________________________________ Fathers Name:_____________________

b) Qualification: ___________________________________(attach attested Copies of Permit)
c) Certificate of employment ______________________________________ (Attach Copies)

Dated:____________________________

Signature of Applicant

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