ELECTRICAL LICENSING BOARD

,
O D I S H A
* * * * * * *

Name of the Person/Firm :

Amount deposited :
Challan No. & Date :
Sl.No.
Signature of Issuing Authority

FORM – “B”
(REGULATION-27)

APPLICATION FOR ELECTRICAL CONTRACTOR’S LICENCE


1. Name (In block letters) in which :
The License is required


2. Business Address :



3. Full Name & Address of Proprietor/ :
Managing Partner/Director
Authorized representative.


4. Category of work for which :
Permanent License is required

Contd….P/2.



-:2:-


5. Details of work project for which :
License/Extension is required.

6. Period for which temporary :
License/Extension is required

7. If a contractor’s license (permanent :
or temporary) was previously issued in the
Same name details to be furnished.


8. Names of Supervisors & Electrical : 1.
Workman to be engaged to be mentioned
2.
(The Ref.No.of S.C.C. and Workman’s
Permits to be furnished), 3.

4.

5.

9. Particulars of Testing Equipments :
available.


10. Details of :


(i) Treasury Challan enclosed :

(ii) Income Tax Clearance Certificate :
and VAT Clearance Certificate.


11. Compliance of other requirement specified :
by the Government.

We hereby declare that the particulars stated above are correct to the best of
my/our knowledge and belief.


Place : SIGNATURE

Date :

DESIGNATION

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