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Form No.

[(Prescribed under rule No. 3 (4)]

1. Name of the Factory : Tyco Electronics Tools (India) (P) Ltd.
2. Village, Town and District in which : Kakkanadu Village, Kanayannoor Taluk,
the factory is situated Ernakulam District

3. Full Postal Address of the factory : M/s. Tyco Electronics Tools (India) (P) Ltd; Plot
No. 44, CSEZ, Kakkanadu, Kochi-682037

4. Name of the occupier of the factory : Sri. Suresh Bhaskaran (Unit Head)

5. Nature of manufacturing process to be : Processing of Tool Components

carried on in the factory

6. Number of floors on which workers : Two

will be employed

I certify that I have Inspected the building/buildings the plans of which have been approved
by the Chief Inspector in his letter No. T3-360/2009/F&B/R.Dis. Dated 18..03..2009 (Permit
No. 48/2009) and examined the various parts including the foundations with special reference to
the machinery, plant etc. that have been installed. I am of the opinion that the building/buildings
which has/have been constructed/reconstructed/extended/taken in to use is/are in accordance with
the plans approved by the Chief Inspector in his letter mentioned above, that it/they is/are
structurally sound and that its/their stability will not be endangered by its/their use as a factory/part
of a factory for the manufacture of TOOL COMPONENTS for which the machinery, plant etc.
installed are intended.
Note: Proposed Extension of Factory building & Security Building not constructed.

Qualification: B. Tech:, M.I.E. , F.I.V, (C) Enggs., A.I.I.S.A
Regn. No.: 281/13/2002/DF&B
Name & Address: V.P. Mohammed Shaji, Vallickada House,
Near Ramco Cements Ltd.,
Kottayam Road, Muvattupuzha, Pin-686661
Date : 15..3..2010