Government of NCT of Delhi

Labour Department
5-Sham Nath Marg, Delhi – 110054
(Electrical Section)

FORM-A
Application Form for grant of Electrical Contractor’s Licence

1. Name of the Applicant: ______________________________

2. Address of the Applicant: _______________________________
3. Full name of the authorized signatory: _______________________________
(In case of a firm or company)
4. Aadhaar No. of the authorized signatory:________________________________
5. Residential address of the authorized signatory:___________________________
_________________________________

6. Constitution of the Firm/Company: Proprietorship/partnership/company registered

under companies Act,2013
7. Details of Prop./Partners/ Directors:
S.No. Name of Proprietor/ Residential address Aadhaar No. of
partners/ Directors Proprietor/par
tners/Directors

8. Details of the license of electrical contractor ship, if any, granted/ revoked/ suspended
to the applicant previously :
9. Details of fee deposited: Amount : Rs. 5000/-
Challan No. __________ Date of deposit: ___________
 10. Following self attested documents are to be attached with the application :
i. Proof of address of the applicant/firm/company and proof of residential address of the
authorized signatory: Yes/No
ii. Copy of Aadhaar card of the authorized signatory: Yes/No
iii. Copy of authorization letter: Yes/ No
iv. Original copy of treasury challan receipt/ online e-payment fee: Yes/ No

Signature of the applicant:____________

Name :____________
Mobile no. :____________
Date :____________

Self undertaking/ self declaration

I ______________________________________ s/o ________________________________ R/o

______________________________________________________________________________
having office premises at _____________________________________________________
hereby confirm and declare that I will employ/ engaged persons having Certificate of
Competency Class-I (Electrical Supervisor) and holder or deemed to be holder of Certificate of
Competency Class-II (Electrician) issued or recognized by the Government of National Capital
Territory of Delhi for executing the works of electrical installations.

2. I will also posses all the testing instruments/ equipment in working condition required for
execution/ testing the works of electrical installations.

3. I do hereby confirm and declare that the information given above and the enclosed
documents to obtain the license to Electrical Contractor ship is true and correct to the best of
my knowledge and belief and nothing material has been concealed therein. I am well aware
that concealment of facts and giving false information is a punishable offence and, in case, I am
guilty of giving false information or concealment of facts herein, I will be liable to be punished
with imprisonment and/ or fine as per the relevant provision of Law. I also undertake that the
benefits availed by me by furnishing such false information or concealment of facts shall be
liable to be summarily withdrawn.

Signature of the applicant: _________________

Name: _________________
Mobile No.:_________________
E-mail address:_________________
Date:_________________