"'al FOl{M NO.

4-13
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Notice of occupation for renewal of License of a Factory

I. N,1111e or the luctory Special Cables Pvt. Ltd

.2. Postal Address.Location Plot no. 60-65, Sec. - No. 03, IIE Sidcul Pantnagar ( UK)

3. License o. ifalready registered USN- 1613

..J. Indicate latest position. ifany change has taken place. against the following
I I' no change has taken place. write ./\.:-

(, \) I lorsc po\\ LT - I 000

( B) Number or workers- 250 (Two Hundred Fifty)

(C) Occupier - Mr. Sushil Kumar Khanna

, I)) Manager- Mr. Mahcndcr Singh

:1. The period lor which renewal or license is applied for w.e.f. Jan- 2021 to Dec. 2021

Ci. Amount or lees deposited - Rs.30600 with late fee 15300

' N.1111e ofTreasury Cheque and Cash deposit

<'. Cheque No.: 077150 Date. 07.11.2019

(J. Challan No. with elate - 17270 date 08/10/2020 and 20 elate 18.01.2021

( Note. -Original Chai Ian must be enclosed)

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Full Signature
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