Affix Court fee

Stamp

Application for licence under Kerala Cinema Regulation Act

1 Name and address of the applicant

.

2 If the applicant is not the owner of the place or

. building the name and address of the owner thereof
and the documentary evidence produced to show that
the applicant is in lawful possession of the site,
building
3 Situation of the place of building
.
4 Area of the place or building in Sq.metre, complete
. plans elevation & Section and block plan on a
seperate sheet, in duplicate to be attached
5 Materials of which the roof, side walls, gallery and
. staircases are made
6 Whether the place or building is to be used during the
. day or night or both
7 Date of last inspection conducted by the following
. authorities and the validity of the certificate issued
(Certificates to be enclosed)
a) The Chief Electral Inspector to Govt. or his
nominee
b) The Exe.Engineer, PWD (Buildings) having
jurisdiction over the area
c) Divisional Officer (Fire force)
d) Health Officer
8 Certifficate No. and the date of the Film Division reg.
. supply of approved film and the period covered
9 Period for which the licence is applied for
.
1 Maximum No. of persons who can be admitted in the Class Nos
0 Auditorium
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.
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1 Fees paid with receipt No. and date
1
.

I have carefully gone through the Kerala Cinema Regulation Act and Rules and I hereby undertake to abide by the rules
and conditions laid down thereunder.
Station
Date: Signature of Applicant