Government of Tamil Nadu Electrical Inspectorate Department FORM "G" APPLICATION FOR RENEWAL OF LICENCE FOR WORKING A LIFT (See rule 5(1) of Tamil Nadu Lift Rules, 1997) To The Inspector of Lifts Sir, Sub:-Application for renewal of Licence for working the Lift at --------------------------------------------------------------------------------- As required under rule 5(1) of the Tamil Nadu Lift Rules, 1997, I/We hereby apply for the renewal of licence for working the Lift and the required particulars are furnished below and request that renewal of licence may be granted:- 1. Full Name and Address of the Applicant : 2. Name and Address of the Local Agent, if any : 3. Address of the place where the Lift has been : erected together with the Name of the Owner thereof. 4. Details of licence previously granted : 5. Whether a challan for renewal fee of Rs.500 : (Rupees five hundred only) for each lift is enclosed? 6. Whether a copy of valid Insurance Policy taken by : the Owner of the Lift covering insurance for persons using the Lift is enclosed. Yours faithfully, Signature of the Owner of the Lift Encl: 1) Challan of Government Treasury 2) Copy of Insurance Policy.
