APPLICATION FOR REGISTRATION AS CONTRACTORS OF ALL CATEGORIES 1. Name of applicant in block letters) 2.

Full address :

3. Officer to whom application is made 4. In the case of individuals who are partners of Ragistered firms or in the case of firms of Contgractors the following details should be furnished. 5. Whether the firm is a private/ public Limited concern or individual Hindu Family individual on a Reg. Partnership firm attested copies of Deep and Articles of Association enclosed 6. Name of partners with their liabilities

: :

7. Name of person holding of Attorney 8. Place of business 9. Category to which Registration is sought 6. Details of financial capacity (enclose solvency certificate of bank guarantee) 7. Particulars of experience on works, labour command, equipment and other facilities on hand and technical assistance available etc. 12. State whether he is registered contractor in any other office in the P.W.D.

: :

13.

States whether the applicant was penalised in connection with any contract with Government If so, give details State whether any of his previous application for registration in any of the offices in Kerala P.W.D. has been rejected State whether the applicant or an any of his partners of shareholders is/are dismissed Govt. Servant (s) State whether the applicant has under his employment, dismissed Government servant State whether the applicant has produced plumbing/electrical licence from completant authority (only in the case of contractors executing the specified works)

14.

15.

16.

17.

I have read and understood tghe rules regarding the Registration of Contractors published in G.O.(P) 69/PW dated 26.4.69 and amended from time to time.

Signature of Applicant.

APPLICATION FOR REGISTRATION AS CONTRACTORS OF ALL CATAGORIES 1. Name of applicant (in block letters) Full Address :

2.

3.

Officer to whom application is made In the case of individuals who are partners of Registered firms or in tghe case of firms of contractors the follwing details should be furnished. Whether the firm is a private/public Limited concern or individual Hindu Family individual on a Reg. Partnership firm attested copies of Deep and Articles of Association enclosed Name of partners with their liabilities Name of person holding of Attorney Place of business Category to which Registgration is sought Details of financial capacity (enclose solvency certificate of bank guarantee) Particulars of experience on works, labour command, equipment and other facilities on hand and technical assistance available etc. State whether he is registered contractor in any other office in the P.W.D. State whether the applicant was penalised in connection with any contract with Government. If so, give details

1.

2.

6. 7. 8. 9.

: : :

: :

10.

11.

12.

13.

14.

State whether any of his previous application for registration in any of the offices in Kerala P.W.D has been rejected State whether the applicant or an any of his partners of shareholders is/are dismissed Govt. Servant (s) State whether the applicant has under his employment, dismissed Government servant State whether the applicant has produced plumbing/electrical licence from competant authority (only in the case of contractors executing the specified works)

15.

16.

17.

I have read and understood the rules regarding the Registration of Contractors published in G.O. (P) 69/PW dated 26.4.69 and amended from time to time.

Signature of Applicant.

APPENDIX 11 (See Rule 31) FORM OFFICE

Name of applicant and place of abode Name of the of the place of building Situation of the place of building Size and description with number of main doors. Material of which the roof and enclosures are made of proposed to be made Whether the licence is annual or temporary Purposae for which the place is proposed to be used Whether the premises are to be used during the day or/and during the night. Provisions for preventing and extinguishing fire Special conditions (if any) on which the licence is granted. Period for which licence is to continued in force Fees paid

Any authority granting a licence under this Act, may, for reasons recorded in writing revoke or suspend the same when he has reason to believe. a) That the licence has been fraudulently obtained. b) That the enclosed place or building has been used for other purposes of public resort of entertainement than that for which the licence was granted: c) That the place or building can no longer be safely used for the purpose for which the licence was granted.

(Signed

(Seal)

(Signature)

AUTHORITY GRANTING LICENCE (Designation