FORM NO.

2
[See rule 4 (2) and 11]
Application for Registration and Grant or Renewal of Licence for the year and Notice of
Occupation specified in Section 7
(To be submitted in Triplicate)
1. Full name of the factory, with factory licence No. If already registered
2. (a) Full postal address and situation of the factory.
(b) Full address to which communication relating to the factory should be sent.
3. Nature of manufacturing process/ processes.
(a) carried on in the factory during the last twelve months (in case of factories already in
existence)
(b) To be carried on in the factory during the next twelve months (in the case of all
factories)
4. Names and Values of principal product manufactured during the last 12 months.
5. (i) Maximum number of workers proposed to be employed on any one day during the year.
(ii)
Maximum number of workers employed on any one day during the last
12 months.
(iii)
Number of workers to be ordinarily employed in the factory.
6. (i) Nature and total amount of power (HP) installed or proposed to be Installed
(ii)
Maximum amount of power (HP) proposed to be used.
7. Full name and residential address of the person who shall be the Manager of the
factory for the purpose of the Act.
8. Full name and residential address of the occupier.
(i) The proprietor of the factory in case of private firm/ proprietary concern.
(ii)
Directors in case of a public limited liability company/ firm.
(iii)
Where a Managing Agent has been appointed the name of Managing
Agents and Directors there of.
(iv)
Shareholders in case of a private company , where no Managing Agents
has been appointed .
(v)
The Chief Administrative Head in case of a Government or local fund
factory.
9. Full name and address of the owner of the premises or building (Including the
precincts there of ) referred to in Section 93.
10. In case of factory constructed or extended after the date of the commencement of the
Andaman & Nicobar Islands Factories Rules, 1951.
(a0 Reference number and date of approval of the arrangements if any, made for the
disposal of trade waste and effluents and the name of the authority granting such approval,
11. Amount of fee Rs (Rupees ) Paid in
Treasury on .. vide challan No. (enclosed) .

Signature of Manager.
Date.
Signature of Occupier
Date..
Notes:- 1. This form should be completed in ink in black letters or typed.
2. If power is not used at the time of filling up this form but is introduced letter, the
fact should be communicated to the chief inspector immediately.
3. If any of the persons named against item s is minor, the fact should be clearly stated.
4. In the case of a factory, where under the provisions of sub-section (1) and (2) of
section 100. a person has been nominated as the occupier, Information required in
item 8 should be supplied only in respect of that person.
In the case of a factory where a Managing Agent or Agents have been appointed as occupiers
information required in item 8 should be supplied only in respect of that person or persons

FORM No. 4
[See Rule 4 (4) ]
REGISTRATION AND LICENSE TO WORK A FACTORY
REGISTRATION No.
Sl. No
Fee Rs.

(Rupees)

License is hereby granted to.

valid only for the premises described below for use as a factory employing not more than. persons
on any one day during the year and using motive power not exceeding H.P. subject to
the provisions of the Factories Act, 1948 and the Rules made thereunder.
This license shall remain in force till the 31st day of December, 19 .
(Seal)
Chief inspector of Factories.
The.19
DESCRIPTION OF THE LICENSED PREMISES
The licensed premises shown on plan No.. dated. as situated in
.. and consist of..

Date of renewal

Date of expiry

N.B :- The licence should be kept in a conspicuous

place of the Factory premises

Signature of Licensing a thirty

LICENCE FEE TABLE

Quantity of horse power

Installed (max. H.P.)

Nil
10
50
100
above 100

Maximum No. of person to be employed

on any day during the year
20

50

100

250

500

Rs.
10
25
50
100
150

Rs.
25
50
75
125
200

Rs.
50
60
100
150
250

Rs. Rs.
125 250
150 300
250
500
375
750
500 1000

750

750 and above

Rs.
Rs.
375
500
450
600
750 1000
1125 1500
1500 2000

RELEVANT RULES
AS PER RULE 4 OF THE A&N ISLANDS FACTORIES RULES, 1970
RULE 4:- Registration and Grant of Licence for a Factory :- (1) No premises shall be used as a
factory, nor any manufacturing process carried on in any factory without the registration of the premises
and the grant of a licence to the Factory by the Chief Inspector.
(2) An application for the registration of a factory and grant of a licence to it shall be submitted to
the Chief Inspector in Form No. 2.
(3) An fees payable for the registration and grant of a licence to a factory shall be as specified in the
schedule hereto. The application in Form No. 2 shall be accompanied by a treasury receipt
evidencing payment of the apprcpriate fee specified in the schedule hereto.
(4) Every application received by the Inspector shall be registered in Form No. 3..
(5) No licence shall be grant until the notice specified in section 7 has been received in duplicate in
Form No. 2 by the Chief Inspector.
(6) If the Chief Inspector is satisfied that the registration and licence may be granted , such
registration and licence shall be issued in Form No. 4 :
Provided that the Chief Inspector may register and grant licence subject to such conditions as he may
consider necessary and which shall be specified in the licence
(7) Every licence granted or renewed under this chapter shall remain in force up to and inclusive of
the 31 st of December of the year for which the licence is granted or renewed.