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Year When amended

Workers

Installed power capacity in H.P

date of payment of amendment fee

Additional fee

Date of fee

Signature of the issuing Authority

Form No. 4

(Prescribed under Rule 5)

LICENCE TO WORK A FACTORY

Licence No…………………. Reg. No……………………….. Date of Reg……………………….. Licence is hereby granted to……………………………. for premises known as ……………… situated at………………………… for use as a fac:-

story within the limits stated hereinafter, subject to provisions of the Factory’s Act, 1948, and the rules made there under.

The……………………………………………. 2O Issuing Authority

	Valid for
Calender Year	Maximum number of workers on any day	Maximum installed power capacity in	Fee	Date of payment	Excess fee of late payment	Date of payment	signature of the Issuing Authority
Granted under rule 5
Renewed under rule 7

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TRANSFERS

To whom transferred	Year of transfer	Date of payment transfer fee	signature of Issuing Authority

AMENDMENTS

Central Bare Acts
State Bare Acts