9 1 Form 1

( 3 ) [See Regulation 3]


BUREAU OF INDIAN STANDARDS
c 9
Product Certification Scheme
[ [ [ [ " H9 HP P H9 H " H9 HP P H9 H " H9 HP P H9 H " H9 HP P H9 H
APPLICATION FOR LICENCE TO USE THE STANDARD MARK

H 9
Full name of individual or firm

Address







H
Office
T[ City H District 7 State T Country Pin


4
Tel

9 4 P
Fax

(-H
E-mail









Address







9 4 |
FACTORY
T[ City H District 7 State T Country Pin


4
Tel

9 4 P
Fax

(-H
E-mail








T4 94H Top Management | 94H Technical Management

Name Designation Name Designation



94 H
Management


P H 4 P.
CONTACT PERSON & Tel No.
1.
2.
3.
4.
1.
2.
3.
4.






CORRESPONDENCE
ADDRESS



[ H-------------- | [ " H9 [ [ 1
This application is being made to use the BIS Standard Mark on -------------------------------------


c
PRODUCT



INDIAN STANDARD



IS: 0s//
" Part:
GRADE/TYPE/CLASS
s Sec:




P 1 H
PRESENT INSTALLED
CAPACITY
(c 94 )
(Production per annum)
c | (|
Units of Production

9
Quantity

~ (.)
Value (Rs.)






HH HH UH 1 /
74 T, ( [ ,
DETAILS OF PREVIOUS CANCELLATION/CONVICTON
IF ANY UNDER BIS ACT


9 | PH
SEAL OF FIRM

[1 H -------------------------------------------
Signature

Name -----------------------------------------------

---------------------------------------------
Designation
H | ------------------------------------
Date of applicaton



[c 1. H 9 P(H H | H 1 HH

9H [1 H [| 1
2. T H P H | 1 9H

9H 9 [1 H H [| 1
3.

P H P H7 P c (|) H9 HP P [ 1

Important: 1. Application should be signed by CEO of the firm, or in his absence by authorized representative.
2. Application from Foreign Manufacturers should be countersigned by authorized Indian representative.
3. Please inform whether you are holding BIS licence(s) for any product(s).
H
Office

1
4s
Large

H
P
Public

9 4 |
Factory
SCALE
H
Small
SECTOR

Private