FORM B

APPLICATION FOR ELECTRICAL CONTRACTOR LICENSE

CATEGORY B.
1.

Name & Address of the company: ______________________________________________

__________________________________________________________________________
Description of the Registered Office. ____________________________________________
__________________________________________________________________________
Nature of business __________________________________________________________
Name, Designation & NIC No. of the person/Director 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).
Registration No. of the Firm from Registrar of the Firmst. _________ (Attach Attested Copy).
Registration No. with General Sales Tax._________________ (Attach Attested Copy).
Detail of previous Contractors License if held _________________ (Attach Attested Copy).
Names, Academic & Technical Qualification of the Director/Partners. (Attach Attested Copy).
Name of holder of certificate of competency on the strength of whose the contractors License
is being sort _______________________________________________________________
Particulars of Testing Instruments (Complete Annex. B-1 & attach original purchase receipts).

2.
3.
4.

5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

Detail of staff employed (Complete Annex. B-1 & attach attested copies of certificates and NIC)

i)
ii)
iii)
iv)
iii)

Fee Rs. 2000/-paid into NBP ___________Branch /vide treasury receipt No. __________
Dated __________ (Attach original copy).
I/We _____________________________________________________ hereby declare that:Particulars stated above and filed in the Annex B-1 are correct to the best of my/our knowledge.
I/We fully understand the terms and conditions under which licence is granted (attach duly signed
copy of terms and condition).
I/We shall submit work commencement and completion reports on the prescribed proforma.
I/We shall supply regular return on any change occurred in the above particulars.
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 Company)

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

Instrument Inspected by:

Name/Designation _________________________
Signature: _______________________________

Documents checked by:

Name/Designation: ________________________
Signature: _______________________________

Page 1 of 3

Annex: B-1

PARTICULARS OF TESTING INSTRUMENTS

1.

Megger (1000 V):

Make: ____________________________
Makers No: _______________________
Range: ___________________________

2.

Megger (500 V):

Make: ____________________________
Makers No: _______________________
Range: ___________________________

3.

Earth Tester:

Make: ____________________________
Makers No: _______________________
Range: ___________________________

4.

Clamp on Meter:

Make: ____________________________
Makers No: _______________________
Range: ___________________________

5.

Safety Gloves

Make: ____________________________

6.

Helmet

Make: ____________________________

PARTICULARS OF THE TECHNICAL STAFF EMPLOYED

ENGINEERS:
1.
a) Name:____________________________________ Fathers Name:_________________
b) Qualification:_________________________________________(Attach Attested Copies)
c) Certificate of Competency No. (B Category): _____________ (Attach Attested Copies)
d) Membership No. of Engineering Council:_______________________ (Attach Attested
Copies)
Diploma Holders
1.

a) Name:________________________________ Fathers Name:_____________________

b) Qualification: _______________________ (Attach Attested Copies of Diploma and Certificate of Competency)

Electrical/Wiremen:
1.
a) Name:________________________________ Fathers Name:_____________________
b) Qualification: __________________________ (Attach Attested Copies of Permit)
c) Certificate of Employment _____________________________________ (Attach copy)
2.
a) Name:________________________________ Fathers Name:_____________________
b) Qualification: __________________________ (Attach Attested Copies of Permit)
c) Certificate of Employment _____________________________________ (Attach copy)

Dated:____________________________

Signature of Authorized Person/Director

Page 2 of 3

TERMS AND CONDITIONS FOR CATEGORY B LICENSE

Page 3 of 3