Rule, 2015

Text

Reproduced from the document India Code holds for this instrument. The Gazette prints Hindi and English side by side and this is the English; the Department's own PDF remains the authority.

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(3) t-~ (~) ~ 2016 ~ ~ ~ ..l ..l _I Online Dynamic CAF Form • Pre Establishment Services A. Department of Environment (MP Pollution Control Board)

1. Consent to Establish (Under Water Act 1974 & Air Act 1981) / Consent to Operate (Under Water Act 1974 & Air Act 1981)

2. Authorization for Hazardous and other waste (Management and Transboundary Movement) Rules, 2016 Application Form (Same for above mentioned services) s. Fields captured In the appllcatlon form Field Type No.

1. Applicant's Name with Designation Text

2. Nationality Text

3. PAN CARD Numeric

4. Mobile no Numeric

5. Email Id Text

6. Industry Name : Text

7. Old lndust.ry Name (if any) Text

8. Site location Address with Survey/Plot/T.C Text No/Khasra No / Pin

9. . Does it fall in: industrial estate, in notified area, in Drop down(N!) of Fields - 4) SIDC, I/A, not in any of these

10. DIC/SIA/IEM No/License No. Alphanumeric

11. District Drop down

12. Tehsil Drop down

13. Block Text

14. latitude & Longitude Two Text field 1S. Constitution Type Drop down (Noof Fields- 8)

16. Regd. Office Address: Text

17. Phone, Fax & web site URL Alphanumeric

18. E- mall for official Correspondence Text

19. Industry Sector : Select Drop Down (No ot fields - 69)

20. Project Cost (Investment in Gross fixed Assets, Numeric cost without depreciation ) ( Rs. in lakhs)

21. Investment in plant and machinery ( Rs. in lakhs) Numeric

22. Scale of industry (l/M/S) Drop down

23. Plant Commissioning /Production Date Date (DO/MM/YYYY)

24. Premises Area in Sq. meters Numeric

25. Built up Area/ Open Area/ Plantation Area (sq m) Numeric

26. Environmental Clearance Check Box

27. Directors' Name Text

28. Designation Text

29. Address+ Phone No of director Alphanumeric

30. Mobile No of director Numeric

31. DIN (Director Identification No.) Alphanumeric Mandatory/ Optional Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory

R/0/G

(Auto Generated) Mandatory Mandatory Mandator,, Mandatory Mandatory Mandator,, Mandatory Mandatory Mandator,, Mandatory Mandatory ✓32_ Application Type Drop Down Mandatory

33. Application date Date (Auto generate,;!) Mandatory

34. Application under Air Act/Water Ac!/ Hazd. Waste Check box Mandatory Rules

35. Explain the purpose of this application and any Text Mandatory other relevant information to be mentioned in the Information under Water Act :

36. Water Code Drop down(No of Fields - 12) Mandatory

37. Water Source Drop Down(No of Fields -13) Mandatory

38. Water Source Text Mandatory

39. Water Consumption Kl/Day Numeric Mandatory

40. Waste Water Generation KL/Day Numeric Mandatory

41. Remarks Text Mandatory

42. Disposal Mode (IND) Drop down(No of Fields - 14) Mandatory

43. Disposal Mode (Domestic) Drop Down(No of Fields - 14) Mandatory

44. Point of Disposal Detalls (Land/River/Public Text Mandatory Sewer/Re~cle/ Any other)

45. Ultimate Final Body (Name the catchment of Text Mandatory natural water course)

46. Discharge Point (Mention discharge point Text Mandatory

49. Tube wells/Boilers Numeric (two fields) Optional

50. Bore wells/D.G Sets Numeric (two fields) Optional

51. Capacity of Pumps{HP) Numeric Mandatory

52. CETP / CSTP Membership Drop down(No of Fields-2) Mandatory

53. ETPChamber Drop Down(No of Fields - 70) Mandatory S4. Capacity Numeric Mandatory

55. Units Text Mandatory

56. Date of Commission! ng Date DD/MM/YYYY

57. STPChamber Drop Down(No of Fields - 70) Mandatory

58. Capacity Numeric Mandatory

59. Units Text Mandatory

60. Remarks Text Mandatory

61. Emission Type Drop down(No of Fields - 4) Mandatory

62. Stack Attached To Drop Down Mandatory (No of fields - 82)

65. Stack Monitoring Facility (SMF) Drop down (Noof Mandatory Fields --04)

66. Fuel Used(e.g LDO, Coal, Wood) Drop Down(No of Fields- 25) Mandatory

67. APC (As per consent) Check box

70. Air Pollution Control Measures Check Box Multiple selection {No of Fields - 27 ) - .... 71. Waste Category Drop down Mandatory .. (Nv-of Fields - 63)

72. Waste Name Dependent Drop down for Mandatory point 70 (No of Fields - 421)

74. Unit Drop down Mandatory

75. As Per Consent (APC) Check Box Mandatory

76. Manaeement of Hazardous Waste Disposal Check Box Multiple Selection Mandatory Raw Material & Product: (Multi Row)

77. Product Name Text Mandatory

78. Unit Drop down(No of Fields - 15) Mandatory

79. Applied Quantity Numeric Non Mandatory

80. Remarks Text Non Mandatory

81. M Per Consent (APC) Checkbox Non Mandatory

82. Name of Main Raw Materials & Au~iliary Text Chemicals Used

83. Unit Drop down

84. Existing Quantity Numeric Non Mandatory

85. Remarks Text Non Mandatory

86. As Per Consent (APC) Checkbox Non Mandatory Solid Waste (Do not Enter Hazardous Waste Details):

87. Waste Name Text Non Mandatory

88. Quantity Per Month Numeric Non Mandatory

89. Unit Numeric Non Mandatory 95). Solid Waste Disposal Multiple check bqx(No of Non Fields - 4) Mandatory

91. Solid waste collection Multiple check box(No of Non Flelds - 4) Mandatory

92. Remarks Text Non Mandatory Documents Required S No Documents Required 2 Satellite imagery of project/ industry site 3 Layout plan of the project/Industry 4 Project report including complete details of manufacturing process/ raw mate rials 5 NOC of Gram sabha / local body 6 Article of Association memorandum of Under standing 7 Compliance of Environment clearance conditions (If applicable) Documents for Water Consent:

f"'i Technical Report on ETP/STP 3 Drawing of ETP/ STP 4 Permission of CGWA (lf applicable} - s Water Cess returns (if applicable) - Documents for Air Consent: ·- 1 Technical Specification of Air Pollution Control Arrangemen\, - 2 Schematic Diagram of Monitoring Facility (Port Hole & Pl~'.•! for:_rn with Spiral ladder) Documents for Authorization for hazardous waste: - 1 Details of SLF/lnclnerator (II applicable) - 2 Li st of haz~ rdous waste generated - 3 Form -4 & 13 -- B. Department of Industry Policy and Investment Promotion

3. Building Plan Approval by AKVN ···., Application Form S.No. Fields Data type Mandatory/ optional

1. Name of applicant Text Mandatory

2. Site area (Sqm) Alphanumeric Mandatory

3. Total built up area (Sqm) Numeric Mandatory

4. Address Text Mandatory

5. Mobile Text Mandatory

6. Email Text Mandatory

7. Phone no. Text Mandatory

8. Fax no. Text Mandatory

9. Building no. Alphanumeric Mandatory

10. Plot no. Or Khasra no. Alphanumeric Mandatory

11. Colony/ mohalla / bazar Alphanumeric Mandatory

12. Village or Town Alphanumeric Mandatory

13. Tehsil Text Mandatory

14. District Text Mandatory

15. Payment details Text Mandatory

16. Engineer/ architect Text Mandatorv

17. Engineer/ architect license no Alphanumeric mandatory

18. Whether land is diverted Drop Down Mandatory

19. Purpose of construction Alpha n umerlc Mandatory

20. Approval from Town and Country Planning Drop Down Mandatory Department (If Located outside Notified Industrial Area) Documents Required S.No Enclosures 1 Required details {annelC. A 2 to a 7) as prescribed in MPBVR-2012 2 Copy of valid license of architect / engineer 3 Receipt of current year property tax 4 Copy of receipt of application fee, labour welfare fee, roof water harvesting fees and other fees prescribed by the competent authority 5 Key Plan/ Combines Site Plan & layout Plan 6 Building Plans

4. Water Connection by AKVN Appllcai:ion Form S.No Flelds captured In the application form

1. Link for Terms and Conditions download (Please refer Annexure 2)

2. Customer Name

3. Unit Name

5. Industrial Area {Annexure 1)

6. Address

7. Plot No.

8. Email

9. Mobile Number

10. Date of Appllcatlon

11. Office of-DTIC

12. Government Registration No

13. Registration Date

14. Water Requirement (Per Day) Minimum

15. Size of Water Connection Applied

16. Application Fees

17. Water Security Deposit (Rs)

19. Total (Amount to be paid in Rs.)

20. Possession Letter

21. This is to certify that the information furnished above is true and correct to the best of my knowledge and belief Documents Required S.No.

I Enclosures Possesskm letter Data type Mandatory/ optional "t AGREE" Check Box Mandatory Text Mandatory Text Mandatory Drop down(No of Fields - 7) Mandatory Drop down(No of Fields - 88) Mandatory Numeric/Text Mandatory Numeric Mandatory Alphanumeric Mandatory Numeric Mandatory Calendar Mandatory Text Mandatory Numeric Mandatory Calendar Mandatory Numeric Mandatory Numeric Mandatory Auto calculated Mandatory Auto calculated Mandatory Auto calculated Mandatory Auto calculated Mandatory Upload Mandatory "I ACCEPT" Check Box Mandatory c. Urban Development and Houslna Department

5. NOC from Fire Department Application Form S.No Fields captured in the Application Data Type Form Applicant Details ' • Mr • Miss • Mrs • M/S

2. First Name Text

3. Middle Name Texts

4. Last Name Text

5. Type of NOC Provisional

6. Mobile No. Numeric

7. Telephone No. Numeric

8. E mail Address Alphanumeric

9. Application Date Date {00/MM/YYYY) (Auto- populate) Address of Appilcant

10. Address Une 1 Alphanumeric

11. • Address Line 2 Alphanumeric

12. City Text

13. Select Your State Dropdown

14. Pin Code Numeric Address of Property

15. Address Line 1 Alphanumeric

16. Address Line 2 Alphanumeric

17. City Text Tvpe of Occupancy

18. Select Your Occupancy Dropdown(No of Fields - 12)

19. Height of Building (in Meters) Numeric

20. PtotArea Numeric

21. Plot area unit Dropdown(No of Fields - 3) Documents Required - Mandatory S.No. Enclosures Mandatory/ Optional Mandatory Mandatory Optional Mandatory Fixed Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory 1 Copy of Ownership Document (Lease Deed/ Registry (Summarized copy)/ Khasra) 2 Building Fire Plans (each floor),Elevation Plan of Building,Sectlon Plan of Building 3 Copy of Certificate of Fire Consulta.nt Qualification (If not listed in Department Website ) 4 Checklist (53 Paints} certified by the fire consultant, owner or authorized person asper rules s Copy of Approval letter and Approved Building plan (each floor) by competent Authority (Scanned ln original size) 6 COpy of Approval letter and Approved layout plan (each floor) by competent Authority (Scanned In original size) Either Sor 6 qm 4 (11)] a. DISCOMs S.No Fields captured In the aoollcallon lorrn

1. Applicant Name

3. Aadhar Mobile No

4. Aadhar Email ID

6. Type of connection

7. Applicatio') Type

8. Type of Electric Connection

9. Start Date (for Temporary connection)

10. End Oate (for Temporary connection)

11. Category of Electric Connection

12. Objective of Electric connection Connection address

13. Khasrn / Plot No

14. ORCLE

15. Block Communication address

18. Same as above

19. PIN code

20. Slate

21. District

22. Applicant/ Firm Name

23. Name of

24. PAN card No

25. TIN No ( in case of Government Agency)

26. Registration No or Firm

27. End Date of Registration '30. Account No

31. Re-enter account number n. Reoulred load (KVA)

33. Required Supply Voltage

34. Contract Demand in phased manner Data Type Text Numeric Numeric • LT Drop down (Auto Populated) Boolean [Radio Button) Date OD/MM/YYYY Date DO/MM/YYYY Drop Down(No of Fields -11) Drop Down (dependent, (No of Te~t Drop Down Drop Down Drop Down Check Box Numeric Text Text Te~t Alphanumeric Alphanumeric Alphanumeric Date (00/MM/YYYY) Drop Down Alphanumeric Numeric Numeric Numeric Drop Oown(No of Drop Oown(No of Fields - 2)

35. If yes, mention contract demand {in KVA) Numeric From Date To Date S.No. Documents Required 1 Registration deed of Land 2 Parmersh·,p Deed/ Proof of propnc tor / certific Mandatory/ Oi:,tlonal Mandatory Mandatory Optional Ootional Mandatory Mandatory Optional Mandatory If electric connection~ temporary If electric connection~ temporary Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Optional Mandatory Mandatory Mandatory Mandatory Mandatory Ootional Optional Mandatory(Opt\onal for Gov Agency) Mandatory(Optional lor Gov Agency) Mandatory(Optlonal for Ootional Mandatory Mandatory Optional Pre Operation Services A. Food. Civil Supplies & Consumer Protection Department

1. License as Manufacturers of Weights & Measures Application Form S.No Fields captured in the application form Data Type 1 Beneficiary's Aadhar Number Numeric 2 Name of Applicant Text 4 Gender Dropdown (No of Fields -3) 5 category Dropdown (No of Fields- 6) 6 Emall Alphanumer!c 7 Mobile No Numeric 8 Address (House No/Mohalla} Alphanumeric 9 District Dropdown 10 Tehsil Dropdown 11 Kshetra Dropdown(No of Fields - 2} 12 Ward Dropdown 13 Name of manufacturing concern for Text whom license is desired 14 Premise Type Radio Button {No of Fields- 3) 1s • Complete address of the concern Alphanumeric whether the land is owned/rented/on lease along with supporting documents 16 Date of establishment of Date (DD/MM/YYYY) 17 Is this limited Company (Yes/No) Radio Button • YES= 01, • NO =02 Director) • Partner = 02, • Managing Director = 03 20 Current registration number of Alphanumeric trade license 21 Date of 00/MM/YYYY trade license 22 Nature of manufacturing activities at Alphanumeric present 23a The types of weights and measures Alphanumeric proposed to be manufactured viz:

Weights Details 23b Measures Details Alphanumeric Be Weighing instruments Details Alphanumeric Mandatorv/ .Optional Optional Mandatory Mandatory Mandatory Mandatory Optional Optional Mandatory Mandatory Mandatory Mandatory Mandatory Mandatorv Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatorv Mandatory Mandatory Mandatory 23cr 24a 24b 24c 24d 31a 31b 36a 36b -q~ ~. ~ 6 ~ 201 8 Measuring instruments Details Alphanumeric The number of persons Numeric ..

employed/proposed to be employed Skilled Semi-skilled Numeric Unskilled Numeric Specialist trained In line Numeric The monogram/trademark. intended to Alphanumeric be imprinted on weights and measures to be manufactured Details of machinery, tools, accessories Alphanumeric owned and used for manufacturing weights and measures etc.

Details of foundry or workshop facilities Alphanumeric arranged. Whether ownership or long Facilities of steel casting and hardness Alphanumeric testing of vital parts etc. Or other means Availability of electrical energy Alphanumeric Whether any loan received from Radio Button government or financial institution. If yes Yes=Ol, give details No =02 Name of bankers Text Loan details Alphanumeric GSTnumber Alphanumeric Professional Tax registration Number Alphanumeric IT Number Alphanumeric Have you applied previously for a Radio Button manufacturer's ltcense? If yes when with Yes=01, what result. No=02 Previously manufacturer's license date Date 00/MM/YYYYY Previously manufacturer's license details Alphanumeric Whether the items proposed to be Radio Button (No of Fields - 3) manufactured will be sold Details of Model Approval received from Alphanumeric Government of lndla {ii) When can you produce for inspection Date DD/MM/YYYY samples of your products for which license Is desired (OD/MM/YYYY) • Documents Required l Scan Copy of Completely filled and signed self-declaration and Consent letter form Model Approval Document from Govt. of India/Application submitted for model approval to Govt. of India Scan Copy of PAN CARD Scan Copy of AADHAR CARD s Scan Copy of Proof of Educational Quali fication 1--6---'- Scan Copy of Certificate of Registration under Sha~~ and Establishment Act .

Scan Copy of Electricity Bill of Premise Scan Copy of Name and AADHAR No of all the workers/Employees Mandatory Optional Optional Optional Optional Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory (if yes) Mandatory {if yes) Optional Optional Optional Mandatory Mandatory (If yes) Mandatory (if yes) Mandatory Mandatory Mandatory nal Mandatory Mandatory Mandatorv Mandatory Opt ional Optional Optional Optional engaged in Manufacturing.(Self Attested) _______ _ Scan Copy of Registration certificate from Indust ries department if registered as factory/ Unit j Optional --i- Optional

2. Consent to Operate (Under WatEii, Act 1974 & Air Act 1981} Application Form - Same as Consent to Establish (Under Water Act 1974 & Air Act 1981)

3. Authorization under E -Waste (Management) Rules, 2016 Application Form S.No Fields Data Type Mandatory/Optional

1. Applicant Type Text Mandatory

2. No. of workers Numeric Mandatory

3. Dismantling or Recycling Process Text Mandatory

4. Waste generation In processing e-waste Text Mandatory

5. Provide details of disposal of residue Text Mandatory

6. Name of Treatment Storage and 0lsposal Text Mandatory Facility utilized for

7. Details of e--waste proposed to be Text Mandatory procured from re-processing

8. Occupational safety and health aspects Text Mandatory

9. Details of Facilities for dismantling both Text Mandatory manual as well as mechanised

10. Details of storage for raw materials and Text Mandatory recovered materials

11. Authorisation required for Text Mandatory

12. Total quantity e-waste generated in Numeric Mandatory

MT/A

13. Quantity refurbished ( applicable to Numeric Mandatory refurbished}

14. Quantity sent for recycling Numeric Mandatory

15. Quantity sent for disposal Numeric Mandatory

16. Oetalts of Storage Fa.dlitles Text Mandatory

17. Details of Handling Faclllties Text Mandatory

18. Details of Treatment Facilities Text Mandatory

19. Details of Refurbishing Facilities Text Mandatory Multiple Records (E-waste Processed during last 3 Years)

20. Year (last 3 Year Processed) Text Mandatory

21. Product {last 3 Year Processed) Text Mandatory

22. Quantity (last 3 Year Processed) Numeric Mandatory Multiple Records (Installed Capacity)

23. Product Name (lnstall~d Capacity) Text Mandatory

24. Capacity (Installed Capacity) Numeric Mandatory

25. Capacity Unit (Installed Capacity) Text Mandatory Documents Required SNo Endosures 1 Copy of agreement with Collection Centre 2 Copy agreement with Producer 3 Details of storage for dismantled e-waste 4 Copy of agreement with Recycler 5 Details of Facilities for Recycling 6 Details of storage for raw materials and recovered materials Application Form S.No Fields Oata Type

1. Name of the local body/agency appointed by them/ Text operator of facility

2. Correspondence address Text

3. Telephone No. Numeric

4. Fax No. Numeric

5. e-mail Alphanumeric

6. Nodal Officer Name (Officer authorised by the local Text body or ;igency responsible for operation of processing/ treatment or disposal facility)

7. Nodal Officer Designation (Officer authorised by Text the local body or agency responsible for operation of processing/ treatment or dis po! a I fa cUity)

8. Authorisation required for setting up and operation 1.Waste of the facility Processinl! {Please tick mark) 2. Recycling

3. Treatment

4. Disposal at Landfill Processlng/recyc:Jlng/treatment of solid waste

9. (I) Total Quantity of waste to be processed per day Numeric

10. (a) Quantitv of waste to be recycled Numeric

11. (b)Quantity of waste to be treated . Numeric

12. (c)Quantity of waste to be disposed into landfill Numeric 13, (ii)Utillsatlon programme for waste processed Numerk:

(Product utilisation)

14. (lH)Methodology for disposal (attach details) Numeric

15. Quantity of leachate Numeric Treatment technology for leachate

16. (lv)Measures to be taken for prevention and Numeric control of environmental pollution

17. (v)Measures to be taken for safety of workers Numeric working In the plant

18. (vi)Details on solld waste Attachment processing/recycling/treatment/disposal facil'tty (to be attached) Olsposal oholld waste

19. Number of sites identified Numeric

20. Quantity of waste to be disposed per day Numeric

21. Details of methodology or criteria followed for site Attachment selection (attach)

22. Details of existing site under operation Numeric

23. Methodology and operational details of landfilling Numeric

24. Measures taken to check environmental pollution Text

25. Any other information. Te><t Documents Required S.No. Enclosures

1. Site clearance (local body)

2. Proof of Environmental Clearance

3. Consent for establishment

4. Agreement between municipal alJthority and operating agency

5. Investment on the project and expected return Mandatory /Optional Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatorv Mandatoty Mandatory Mandatory Mandatory Mandatory

5. Factory Plan approval under the Factories Act, 1948 • Application Form Partiwlars of the drawings along with information is submitted according t o the requirement of Rule 3-A S,No Fields captured In the application form Data Type Mandatory/ Details of Applicant 1 Name of Occupier Text Mandatory 2 Father's name Text Mandatory Aoollcant's address on whtch he wants corrosoondence In this regard 3 Address Alphanumeric Mandatory 4 State Drop down Mandatory 5 District Drop down Mandatory 6 Pin Code Numeric Mandatory 7 Mobile No Numeric Mandatory 8 E Mail ID Alphanumeric Mandatory 9 Aadhar No. & Passport (In case of Aadhar Is not Numeric Manda-tory avallable with NRI) Full Name and address of the Factory 10 Factory NarT)e Text (with special Mandatory chars.) ll Postal address of factory Alphanumeric Mandatory 12 District Drop down Mandatory 13 Division Drop down Mandatory 14 Pin Code Numeric Mandatory Manufacturing PfOQ!SS 15 To be carried (If new factory)/t>elng carried (if e)llxts) Text Mandatory give description 16 Whether it Involves hatardous processes as interpreted Drop down Mandatory under section 2 (cb) (give details) In case of YES 17 Whether It Involves any dangerous opero1tion wholly or Drop down Mandatory partly, as declared under sub-rule (1) of the rule 107 In case of YES under sectlon87 (give details) Workers Details 18 No. of workers employed in every room In Factory Numeric Mandatory Details of Machines 19 Whether lifts/hoists/LI ~i ng Ma chines of a nv kind Drop down(No of Mandatory ln~talled/ to be Installed In the plant. If yes, the same Fields- 2) should be shown in drawing.

Job Description 20 Whether w011ter will be required to work at different Drop down(No of Mandatory floors or at a height from where he Is likely to fall or Fields- 2) work at a congested place due to machines or fittings or In a confined space, pit or sums? Escape of d,1ngerous fumH /gases / fire or explosions details: 21 Whether there ls any possibility of escape of dangerous Drop down(No of Mandatory fumes/ gases/ fire or explosions? Fields - 2) Wh11t materials are used / to be used for construction of 22 I Building (give details) I Text I Mandatory 23 I Roofing (give details) I Text I Mandatory Industry under Factory Act 1948 24 I Type of Factory I Drop down I Mandatory 25 I No. of Workers expected I Drop down I Mandatory Documents Required S.No. Enclosures

1. Brief description of process ;i iong with list of Raw material wit h qu~ntity to be used in manufacturing proces, Drawings - As per rule 3-A of Madhya Pradesh Factones Rules, 1962, site plan drawn to scale n~ t less than 1:500 and plan, elevation, cross section, of various buildings including a\\ details relating to door, windows, ventilators, emergency exits, lay out of plant & machinery drawn to scale not less than 1:100. (Only upload pdf generated by AutoCAD software I Details e>f materials used for building construction ~nd roofing. _ _ _ __ _ ___ __

6. Factory Ucense under the Factories Act, 1948 Application Form FORM- 4 (Prescribed under Rule 6,7,8 & 10) Application for Registration and Grant or Renewal of License for the Year and notice of occupation In section 6 and 7 S.No Flelds captured In the application form Data Type Mandatory /Optional Factory Details 1 FAC.No. Numeric Optional 2 Factory Name Alphanumeric Mandatory 3 LIN Number Numeric Optiona I (As per 601 directions) 4 Factory licence if already registered Drop down Mandatory

1. Yes

2. No If Yes License No 5 Application for the Registration of License for Drop down Mandatory the Year Full Postal Address and situation of factory 6 Address Alphanumeric Mandatory 7 District Oropdown Mandatory 8 Division Drop Down Manda~ory 9 Pin Code Numeric Manda1ory 10 Whether Factory Address is same as Check Box Optional •No If 10 Is no, Full Postal Address to which communication relating to factory should be sent 11 Address Alphanumeric Mandatory 12 State Oropdown Mandatory 13 District Drop down Mandatory 14 Pin Code Numeric Mandatory Full name and resldentlar address of the person who shall be the o"upler of the factory for the purpose of the Act 15 Full Name of the Occupier Text Mandatory 16 Father's Name Text Mandatory 17 Category of occupier Drop down Mandatory Proprietor/ Partners in the Firm/ Director of Company /others 18 Address Alphanumeric Mandatory 19 State Drop down Mandatory 20 District Drop down Mandatory 21 Pin Code Numeric Mandatory 22 Mobile No Numeric Mandatory 24 Aadhar No. & Passport (in case of Aadhar is Numeric Mandatory not available with NRI) Full name and residential address of the person who shall be the manager of the factory fC>r the purpose of the Act 25 Full Name of the manager Text Mandatory 26 Father's Name Text Mandatory 28 State Drop down Mandatory 29 District Drop down Mandatory 30 Pin Code Numeric Mandatory 31 Mobile No Numeric Mandatory 32 Email ID Alphanumeric Mandatory Full name and residential address of the owner of the premises or building [including the precincts thereof) referred to in Section 93 of the Act 34 Full Name of the Owner Text Mandatory 35 Father's Name Text Mandatory 36 Address Alphanumeric Mandatory 37 State Drop down Mandatory 38 District Drop down Mandatory 39 Pin Code Numeric Mandatory 40 Moblle No Numeric Mandatory 41 Email ID Alphanumeric Mandatory 42 Aadhar No. & Passport (in case of Aadhar is Numeric Mandatory not ava:lable with NRI) Nature of manufacturing process or processes 43 Carried on in the factory in the last 12 Text Optional months (In case of factories already in existence) 44 to be carried on in the factory during the next TeKt Mandatory 12 months (In the case of all factories) 4!; Whether It Involves hazardous processes as Drop down Mandatory interpreted under Section 2 (cb) give details In case of YES 46 Whether It Involves any dangerous operation Drop down Mandatory wholly or partly, as declared under sub-ryle In case of Yes

(1) of the rule 107 under section 87 (give detalls) 47 Whether any chemical substance as specified Drop down Mandatory under second schedule of the Act is used, 1. Yes handled, stored or processed thereat 2. No Worker Details 48 Fee Schedule Applicable Drop down Mandatory Schedule A- Schedule B- Schedule C- 49 Maximum Number of worker proposed to be Drop down Mandatory employed on any one day during the year (No of Fields - 26) so Maximum Number of workers employed on Drop down Optional any one day during the last twelve months (in (No of Fields - 26) case of factories already in existence) 51 Number of workers to be ordinarily employed Numeric Mandatory in the Factory Nature and total amount of powers (HP) 52 Installed Machinery Power in Horse Power Drop Down: Mandatory For Schedule :..

Schedule B Schedule C Reference numbersls) and date (s) of approval of plans under rule 3-A of M.P factories Rules 1962 by chief Inspector of factories, MP (in case of factories already in existence) 53 Reference Number(sl meric Optional

I----- - - - -

54 , Date of Appro•,al _ te (DIJ/MM/YYYY) Optional Documents required- in case of New Licence General documents: For Non - Hazardous & Hazardous Category 1 Proof of Ownership/possession of Premises (Sale Deed/Rent Deed/Lease Deed eTc.) 2 Proof of being 0ccupant(Proprietor / Partners in the Firm/ list of Director of Company+ Memorandum & Article of Associations) 3 Stability certificate Form no.-2 issued by a competent person 4 Copy of self cess assessment Form-1 under B0CW Act, 1996 Addltlonal documents: For Hazardous Category 1 Proof of submission of On-Site Emergency Plan.

2 If Pressure vessels and lifting machines are installed, Test Report issued by Competent Persons in case of solvent plants• Plant fitness certificate and operator fitness certificate Issued by a competent person is also required.

3 A copy of Bill Issued by Madhya Pradesh Electricity Board as a proof for installed horse power 4 Name & Max Quantity of Chemicals & Raw Material to be used and stored in premises.

7. Permission for engaging Contract labour by a Contractor under provisions of the Contract Labour (Regulation and Abolltlon) Act, 1970.; (Licensing of Contractor) ·-1 • Application Form S.No Fields captured In the appllcation form Data Type I Mandatory / Optional Contractor Information 1 (i) Name of Contractor/ Contractor Text Mandatory Establishment

(ii) Name of father/ husband (if Contractor Text Mandatory is Individual) l Address Alphanumeric Mandatory 3 PIN Code Numeric Mandatory 4 Telephone no Numeric Mandatory 5 Email ID Alphanumeric Mandatory 6 Mobile Number Numeric Mandatory 7 District Drop down Mandatory 8 Nearest labour Office in the District Drop down Mandatory (Issuing Office) 9 Aadhar No. (if Contractor is Individual) Numeric Mandatory 10 Date of Birth {If Contractor is individual) Date (DD/MM/VYYY) Mandatory Applicant Details (Applicant Information- if applicant is other than Contractor) Boolean 11 Name of Applicant Text Mandatory 12 Father's/ Husband's Name Text Mandatory 13 Designation (applicant's status in the Drop down Mandatory firm) (No of Fields - 5) 14 Applicant's address for Correspondence Alphanumeric Mandatory 15 Mobile Number Numeric Mandatory 16 Email ID .~lphanumeric Mandatory 17 Aadhar No. Numeric Mandatory 18 Date of Birth Date (DD/MM/YYYY) Mandatory Details of Principal Employer / particulars of establishment / Institution to whom contractor s1Jpp11es ·contract labour 19 Name of PE Establishment Text Mandatory 20 Address of PE Establishment Text Mandatory 21 Certificate of registration for Alphanumeric Optional establishment (Principal Employer file number) 22 Date of Registration Date (DD/MM/YYYY) Optional 23 Issuing office Drop down Mandatory 24 Name of the Owner / Occupier/ Director Text Optional / Manager who is responsible for the affairs of employment of Contract labour in PE Establishment 2S Address of the Responsible person PE Text Optional 26 Mobile no. Alphanumeric Optional Specifications of Contract Workers 28 Nature of the work for which contract Text Mandatory labour is employed in the establishment 29 Maximum number of contract workers to Numeric Mandatory be employed 30 Proposed start date of contract work Date (DD/MM/YYYY) Mandatory 31 Proposed end date of contract work Date (DD/MM/YYYY) Mandatory 32 Contractor's Agent or Manager's Name Text Optional 33 Address of the Agent or Manager Alpha nu rneric Optional Other Details 34 Has the contractor been convicted of any Boolean Mandatory crime In the last five years? 35 If yes, then details Text In case of Yes 36 Was there any order to cancel or Boolean Ma.ndatorv suspend the license against the contractor or forfeiture of the security deposit ever? 37 Date of Order Date (DD/MM/YYYY) In case of YES 38 Has the contractor worked in any other Boolean Mandatory establishment during last five years? 39 Name of the Principal Employer Text In case of YES 40 Establishment's Name Text In case of YES 41 Nature of Work Text In case of YES Documents Required 1 Passport size photograph of Applicant (JPG) 2 Copy of any one photo Identify of applicant Voter ID/ Aadhar/ Driving License/ Passport or PAN card (PDF Format) 3 Certificate in Form V issued by Principal Employer under Rule 21 (2) of Permission for engaginag contractor for contract labour under provision of l"he Contract Labour (Regulation anc::l Abolition) Act, 1970 'IWT 4 (TJ) ]

8. Registration of Principal Employer Establishment under the Inter-state Migrant Workers Act,1979 Appltcation Form S.No. Fields captured In the appllcatlon form Data Type Mandatory/ Optional Establishment Details 1 Name of Establishment (English) Text Mandatory 2 Name of Establishment (Hindi) Text Mandatory 3 Address Alphanumeric Mandatory 4 PIN CODE Numeric Mandatory 5 Telephone No. Numeric Mandatory 6 Fax No. Numeric Optional 8 District Drop Down Mandatory 9 Issuing Office Drop Down Mandatory 10 Nature of work carried on in the Text Mandatory Establishment Applicant Details 11 Name of Applicant Text Mandatory 12 Fathefs/ Husband Name Test Mandatory 13 Status of Applicant Drop Down!No of Mandatory 14 Mobile No. Numeric Mandatory 16 Aadhar No. Numeric Mandatory Principal Employer Details (not appllcable if applicant & Principal Employer are same) 17 Name of Principal Employer Text Mandatory 18 Address Text Mandatory 19 Mobile No. Numeric Mandatory Manager Detail5 (not accllcable if applicant & manager are the same) 21 Manager Name Text Mandatory 22 Manager Father/ Husband Name Text Mandatory 23 Manager Mobile No. Numeric Mandatory Par1lcul.irs of All CONTRACTORS and ISM worker employed by them (Multiple entries populated in grid) 25 Name of Contractor Text Optional 26 Address Text Optional 27 Nature of Work Text Optional 28 Nature of work to be carried by the Text Optional contractor in Establishment 29 Maximum no. of contract labour to be Numeric Optional employed In any day by this Contractor 30 Estimated Date of Termination of Calendar Optional employment of contract labour +ADD CONTRACTOR Documents Required

1. Passport size photograph of Applicant (JPG)

2. Photo Identity Proof of applicant - (Vnter ID, Aadhar, Driving license, Passport, PAN Card (anyone)) Copy of any one for address/ place p, oof of Principal Employer/ Contractor EstablishrTJent Rent agreement, Electricity Bill Telep!·,, ,rie Bill. Ownership deed, Pannership deed, Memorandum of Association - Copy of Contract in case of Partnership firm and Copy of Memorandum of Association in 4. I case of Limited company - - - - 414 ,p-~ ~, ~ 6 ~ 2018

9. Registration of Establishments under the Building and Other Construction Workers (Regulatlon of Employment and Conditions of Service) Act, 1996 Applicatlon Form S.No Fields captured In the application Data Type Mandatory/ form Optional Establishment Details 1 Name of Establishment {English) Text Mandat'>ry 2 Name of Establishment (Hindi) Text Mandatory 3 Present Address of Establishment Alphanumeric Mandatory 4 Pin Code Numeric Mandatory s Permanent Address ( If Any ) Alphanumeric Optional 6 Pin Code Numeric Optional 7 Complete Address of the place of Text Mandatory construction 8 Telephone No. Numeric Mandatory 9 Fax No. Numeric Optional 10 Email Id• Alphanumeric Mandatory 11 District* Drop Down Mandatory 12 Nearest Labour in the District (Issuing Drop Down Mandatory Office) Appllcant/ Employer Details 13 Name of Applicant TelCI: Mandatory 14 Father's/ Husband's Name Text Mandatory 15 Address Test Mandatory 16 Status of Applicant Drop down(No of Fields- Mandatory 17 Email ID Alphanumeric Mandatory 18 Aadhar Numeric Mandatory Details of Manager/ person responsible for supervision & control of establishment 20 Manager Name Text Mandatory 22 Address Alphanumeric Mandatory 23 Manager Mobile no. Numeric Optlonal 24 Email ID Alphanumeric Optional Work Details 25 Estimated Date of Commencement of D:ate (DD/MM/YYYV) Mandatory Work 26 Estimated Date of Completion of work Date (DD/MM/VYVY) Mandatory 27 Maximum number of labour to be Drop down Mandatory employed in any day Documents Required i:, No Documents Required

1. Passport size photograph of Applicant (JPG}

2. Copy of Applicant photo ID (any one voter 1D, Aadhar card, Driving License; either Passport or PAN) (in PDF Format)

3. For the authentication of Construction Establishment place and address copy of any one Rent Agte'ement Telephone bill Electric payment Ownership deed Partnership deed Memorandum of Association

4. Copy of contract in case of partnership firm OR In case of Company Ltd copy of memorandum of association (PDF Format)

10. Registration of Principal Employer Establishment under Contrac:t Labour (Regulation and Abotitlon) Act, 1970 Application Form S.No Fields captured in the application Data Type Mandatory/ form Optional Establishment Details l Name of Establishment (English) Text Mandatory 2 Name of Establishment (Hindi) Text Mandatory 3 Address Alphanumeric Mandatory 4 Pin code Numeric Mandatory 5 Telephone No. Numeric Mandatory 6 Fax No Numeric Optional 7 Aadhar No (In case of person) Numeric Mandatory 8 Email Id Alphanumeric Mandatory 9 District Drop down Mandatory 10 Nearest labour Office in the District Drop Down Mandatory 11 Nature of work carried on in the Drop Down Mandatory Establishment Applicant's Details 12 Name of Applicant Text Mandatory 13 Father's/ Husband's Name Text Mandatory 14 Status of Applicant in the Drop down Mandatory Establishment 15 Mobile No. Numeric Mandatory 16 Email Id Alphanumeric Mandatory :: Prlnclpal Employer Details ::

18 Name of Principal Employer Text Mandatory 19 Address Alphanumeric Mandatory 20 Mobile No. Numeric Mandatory 21 Email Id Alphanumeric Mandatory Manager Details (not applicable if applicant is manager himself) 22 Manager Name Text Mandatory 23 Manager Father/Husband Name Text Mandatory 24 Address Alphanumeric Mandatory 2S Manager Mobile no. Numeric Mandatory 26 Email Id Alphanumeric Mandatory Particulars of all Contractors and Contract labour employed by them (Multiple values captured In a Grid) 28 Name of Contractor Text Optional 29 Address Alphanumeric Optional 30 Nature of Work for which Contract Text Optional Labour is engaged.

31 Maximum number of contract labour Drop down Optional to be employed on any day by this contractor 32 Proposed date of Termination of Date (DD/MM/YYYY) Optional ,-Contract +ADD CONTRACTOR Documents Required SNo Documents Required Passport size photograph of Applicant (JPG) Copy of Applicant photo ID (any one voter ID, Aadhar card, Driving License~ either Passport or PAN) (in PDF Format) For the authentication of place and address of establishment copy of any one • Rent Agreement • Telephone bill • Electric payment • Ownership deed• • Partnership deed• (•If these documents have many pages than scan and upload only consistent information pages only in POF format) Copy of contract in case of partner in partnership firm and Copy of memorandum of association In case of Limited company.(PDF Format)

11. Registration of Shops and Commercial Establishments under MP Shops and Establishments Act, 1958 Appllcatlon Form S.No Flelds captured In the application Data Type Mandatory/ form Optional Applicant Details 1 Name of Applicant Text ' Mandatory 2 Father's/ Husband's Name Text Mandatory 3 Applicant's Status In the Shop/ Drop down Mandatory Establishment 4 Labour Identification Number (LIN) Numeric Optional 5 Date of Birth (00/MM/YYYY) Date (DD/MM/YYYY) Mandatory 6 Address of Applicant Text Mandatory 7 Mobile No Numeric Mandatory 8 Email Id Alphanume;ic Mandatory 9 Aadhar No. Numeric Mandatory Family Members/ Other Partners Involved in the business (Multiple Entries Added to a Grid) 10 Name of Family Member/ Other Text Optional Partner 11 Designation Text Optional 12 Address Text Optional [(Add more)) - Button to add more members) Shop/ Establishment Details 13 Name of Shop/ Establishment Text Mandatory 14 Address Text Mandatory 15 District Drop Down Mandato;y 16 Issuing Office / Nearest Labour Office Drop Down Mandatory \n the District 17 Category of Shop/Establishment Drop down{No of Fields - 4) Mandatory 18 Business Type Drop Down Mandatory Dependent on Category of Shop/ Estb.

19 Shop Type (Employee Wise) Drop down (No of Fields -4) Mandatory 20 Day of Weekly Off Drop down (No of Fields - 8) Mandatory 21 Owner Type Drop Down Mandatory

1. Proprietorship

2. Partnership

3. Limited Firm 22 Business Start Date Date (DO/MM/YYYY) Mandatory 23 No. of Years for Registration Numeric '5' Manager and Employees Details 24 Manager Name Text Mandatory 25 Manager Father/Husband Name Text Mandatory 26 Date of Birth(DO/MM/YYYY) Date (DD/MM/YYYY) Mandatory 27 Manager Mobile no. Numeric Mandatory 28 Address Alphanumeric Mandatory 29 Number of Employees, Male and Numeric Mandatory Female. j Male I Nos] J remale [ Nos I ' 30 Name of Account/ Business Executive Te1(t Mandatory 31 Address of Account/ Business Text Mandatory Executive Documents Required S.No Documents Required

1. Passport size photograph of Applicant (JPG)

2. Copy of Applicant photo ID (any one voter ID, Aadhar card, Driving License, either Passport or PAN) (in PDF format}

3. For the authentication of place and address of shop & establishment copy of any one (PDF) Rent Agreement ,Telephone bill ,Electric payment ,Ownership deed*,Partnership deed* Memorandum of Association•(*lf these documents have many pages than scan and upload only consistent information pages only in PDF format)

4. Photograph of shop/ establishment in which name panel is visible. (JPG/ PDF format) 5, Partnership deed/ MOU (PDF) - In case of Company/ Partnership firm o. Department oflndustcy Policy and Investment Promotion

12. Registration under Boli~i Act, 1923 Application Form S.No Fields captured in the application form Data Type 1 Type of Registration Radio button • Boiler • Small Industrial boiler • Economiser 2 Type of Boiler Drop down(No of Fields- 5) 4 Name of Manufacturer Alphanumeric 5 Boiler/ Economiser Works Number Alphanumeric 6 Manufacturing place Alphanumeric 7 Manufacturing year Numeric 10 Power generation in MW Numeric 11 Maximum Working Temperature in° C Numeric 12 Piping Involved Drop down !No of Fields-2) Documents Required S.No Documents Required 1 IBR Certificate form : II (1) or II (2) 2 Form Ill 4 Form IVA 5 Form VII 6 Form VIII 7 Form XVII 8 Steam pipe line Drawing Duly Signed by Owner 9 Registration Certificate of Contractor 10 Certificate of Welder 11 Details of Supervisor Mandatory/ Optional Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory --,_ 13. Transfer of Boiler under Boller Act 1923 Applicatlonform S.No Fields captured in the application Data Type Mandatory/ form Optional 1 Type of Registration Radio button(No of Fields - Mandatory 2 Registration number Alphanumeric Mandatory 3 Type of Boiler Drop Down(No of Fields - Mandatory 4 Total Heating Surface Area (Sq mt.) Numeric Mandatory s Name of Manufacturer Alphanumeric Mandatory 6 Manufacturing place Alphanumeric Mandatory 7 Manufacturing year Numeric Mandatory 8 Maximum "Evaporation (Tonne/Hr) Numeric Mandatory 9 Maximum Working Pressure Numeric Mandatory 10 Power generation in MW Numeric Mandatory 11 Maximum Working Temperature in ° Numeric Mandatory C 12 Piping Involved Drop down (No of Fields - Mandatory Documents Required 5.No Documents Required 1 Form 20 2 Steam pipe line drawing duly signed by Owner .

3 Registration certificate of Contractor 4 Certificate of Welder 5 Details of Supervisor

14. Manufacturing of Boilers under Boiler~ Act 1923 Application Form S.No Fields captured In the application Data Type form 1 Name of Firm Alphanumeric:

2 Firm Type Drop down. In addition to Drop Down(Additlonal No of Undertaking) 3 PAN Alphanumeric 4 TAN Alphanumeric 5 EPFO Registration Alphanumeric 6 ESI Registration Alphanumeric 7 Telephone Numeric 8 Fax Numeric 9 Website URI Alphanumeric 10 Official Email ld Alphanumeric 11 Block No/ House No/ Plot No Alphanumeric 12 Road/Street/Land Alphanumeric 13 Area/Locallty Alphanumeric 14 Pin code Numeric 15 District Drop Down Mandatory/ Optional Mandatory Optional Optional Optional Mandatory Optional Optional Optional Mandatory Mandatory Mandatory Mandatory Board Member Detail (Add button required in case of more than 1 member, for rows to be added) optional , Service Specific 16 Members Name Text Mandatory 17 Gender Drop Down(No of Fields - 3) Ma!ldatory 18 category Drop Down (No of Fields 6) Mandatory 19 Knowledge level Drop Down(No of Fields 6} Mandatory 20 Equity Participation (in rupees) Numeric Mandatory 21 Equity Participation {in%) Numeric Mandatory Contact Person Details 22 Representative Name Text Mandatory 23 Mobile Number Numeric Mandatory 24 Aadhaar Number Numeric Optional 25 Email Alphanumeric Mandatory Documents Required S.No. Documents Required 1 Drawing 2 Certificate of Welder 3 Registration Certificate

15. Registration & Renewal under Boiler Act 1923 to work as Manufactlii°e(/Repairer/Erettor Application Form S.No Fields captured in the application form 1 Application for (multiple selection are allowed} 2 Class I Documents Required S.No Documents Required 1 Form XVIII:

2 Details of Machinery :

3 Details of Manpower :

4 Details of Employed Welders :

5 Registration Certificate :

6 Details of Workshop :

7 Details of Power(Electricity) :

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.~ ~~'I-TY I No.B-3243 Tl~ ~, ~ 6 ~ 2018 433 Jabalpur, the 26th June 2018 AMENDMENT IN "THE HIGH COURT OF MADHYA PRADESH RULES, 2008 u Sub-rule 3 (A) of rule 18 in chapter-XII as published in the Madhya Pradesh Official Gazette Notification dated 6th April 2018 [Part-IV (11)] is withdrawn.

By order of Hon'ble the Chief Justice, A. K. SHUKLA, Registrar General.