Schedule 5A [See rule 12 (1)] FORM LM-1 [Application for licence as Manufacturer of Weights and/or Measures under the Standards of Weights and Measures (Enforcement) Act, 1985]. To SI Commodity to be filled Comments of No. by the the Inspecting applicants Officer (1) (2) (3) (4) 1. Name of the manufacturing concern for which licence is desired : 2. Complete address of the concern : 3. Date of establishment of workshop/ factory : 4. Name (s) address (es) of proprietor (s) and/or partners and managing directior (s) in the case of Limited company : 5. The date and number of registration in the case of a Registered Factory : 6. Number and date of current Municipal Trade Licence : 7. Nature of Manufacturing activities at present : 8. The type of articles proposed to be manufactured viz.: (i) Weights (ii) Measures (iii) Weighing Instruments (iv) Measuring Instruments with details in each case : 9. The number of persons employed in each of the above branches of production (i) Skilled ................................. (ii) Unskilles ............................. (iii) Specialists trained in the line : (1) (2) (3) (4) 10. The monogram or trade mark intended to be imprinted on articles to be manufactured : 11. Details of machinery, tools, accessories, etc., owned and used for manufacturing weights, measures, etc. : 12. Have you a foundry/workshop on ownership or long-term lease ? If not, state the nature and details of arrangements made or to be made in this Regard. : 13. Indicate facilities for steel casting and hardness testing of vital parts : 14. Is electric energy available? : 15. Have you received any loan from Government ? If so, give details : 16. Name of bankers, if any : 17. Sales Tax Registration Number : 18. Give details of quota allotment of raw material for the last three years : 19. Have you applied previously for licence? If so, with what, results : 20. When can you produce for inspection samples of your products for which licence is desired? : To be certified by the applicant Certified that I/We have read the Standards of Weights and Measures (Enforcement) Act, 1985 and Srandards of Weights and Measure (Enforcement) Rules, 1986 and agree to abide by the same and also the administrative orders and instructions issued for to be issued thereunder. I/We agree to deposit the Schedule licence fees with Government as soon as required to do so by the Licensing Authority. All the information furnished above is true to the best of my/our knowledge. Place: Date : Signature and Designation To be filled by Department Officer of the State Government Date of receipt of application .................................................................. Serial No. of application .......................................................................... Date of inspection ..................................................................................... Recommendation of Inspecting Officer: Place : Date : Signature and Designation of Inspecting Officer. Final Orders of Licensing Authority Licence granted/refused ....................................................... Licence Number ................................................................... Valid till ................................................................................ Place : Date : Signature and Designation
