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Form I

This document is an application form for permission to construct, extend, or use a building as a factory, requiring detailed information about the occupier and the factory. It includes sections for worker demographics, manufacturing processes, raw materials, and chemical usage, along with a checklist of required accompanying documents. The form emphasizes the need for accurate information and timely updates to the department regarding any changes.

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Chaitanya K.B
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127 views2 pages

Form I

This document is an application form for permission to construct, extend, or use a building as a factory, requiring detailed information about the occupier and the factory. It includes sections for worker demographics, manufacturing processes, raw materials, and chemical usage, along with a checklist of required accompanying documents. The form emphasizes the need for accurate information and timely updates to the department regarding any changes.

Uploaded by

Chaitanya K.B
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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“FORM No.

1
(See rule 3A)
Application for permission to construct, extend or take into use any building or
premises as a factory

1. Details of Occupier
(a) Name:
(b) Address of office with
pin code:
(c) Address of residence
with pin code:
(d) Contact number and
email id:
2. Details of factory
(a) Full name:
(b) Address with pin
code:
(c) District:
(d) Town or village:
(e) Nearest Police Station
(f) Contact number and
email id:

3. Name of Manufacturing
Process and particulars of
plant to be installed

4. Maximum number of
Male Female Transgender Total
Workers
(To be employed)

5. Details of,-
(a) Raw material used
(b) Intermediate product/by product
6. Use of Chemicals in the manufacturing process, if any

S. No. Trade name: Chemical name: Maximum storage


at any time:

7. NOTE:
(a) In case of any change in the above information, Department shall be informed in
writing within 30 days.
(b) Seal bearing “authorized signatory" shall not be used on any document.

Place:
Date:
Signature of occupier with seal:
( Name )

CHECKLIST

NOTE: This application shall be accompanied by the following documents:-

1. A flow chart of the manufacturing process supplemented by a brief description of the


process in its various stage.

2. Plans drawn to scale as per rule 3A, showing:

(i) the site of the factory and immediate surroundings including adjacent buildings
and other structures, roads, drains, etc.; and

(ii) the building & machinery layout plan, elevation and necessary cross-sections of
the various buildings indicating all relevant details relating to natural lighting,
ventilation, means of escape in case of fire (see rule 63)and any other provisions
as mentioned in Chapter III “Health”, Chapter IV “Safety” and Chapter V
“Welfare” of the Factories Act, 1948 and rules made there under. The plans
shall also clearly indicate the position of the plant and machinery, aisles and
passage-ways.

3. Documents related to the ownership of the land:

(i) RIICO lease deed / Land use conversion document (in case land is not in RIICO
industrial area); and
(ii) Rent deed / lease deed

4. Safety & Health Policy:


(i) in case of factory covered under clause (cb) of section 2 of the Factories
Act, 1948; or

(ii) in case of factories covered under Rajasthan Control of Industrial Major


Accident Hazards Rules, 1991 (RCIMAH), Submission of additional
information / documents required under rule 7 of these rules.
5. Photo ID and address proof of the Occupier and Factory Manager.
6. Such other particulars as the Chief Inspector may require.
7. Any correction made in the Form should be duly signed by the Occupier.

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