Department of Puducherry

Department of Revenue and Disaster Management

O/o the Legal Metrology

SCHEDULE-II A

[See rule 11(1)]

FORM LR-1

Application Form for Licence as Repairer of weights and measures under the Legal Metrology Act, 2009

Applicant Details

1. Name of concern seeking the licence *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

2. Complete address of the workshop *

Address Line 1 *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Address Line 2 *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Address Line 3

Country *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

State *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

District

Postal / Zip Code *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

3. (a) Whether premises are owned /rented/taken on lease duly supported by documents *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

(b) Date of establishment *

---pendingNotExist---

---pendingEnd--- ---pendingExist--- ---pendingEnd---

4 a.Name(s) of the Proprietor(s) and / or Partners and Managing Director(s) in the case of Limited Company *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

b. Father / Husband Name *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

c. Address of Proprietors / Partners *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

5. Number of shop/ establishment/ current Municipal Trade Licence *

Name of the Shop/Establishment

Trade License No.

Date of Establishment

Name of the Shop/Establishment

Trade License No.

Date of Establishment

6. Professional Tax/Income Tax registration number etc. If any *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

7.The type of weights and measures proposed to be repaired *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

8. Area of operation willing *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

9. Previous experience in the line *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

10. Number of staff employed or proposed to be employed- *

i. Skilled

ii. Semi-skilled

iii. Unskilled

iv. Employees trained in the line

i. Skilled

ii. Semi-skilled

iii. Unskilled

iv. Employees trained in the line

11. details of machinery, tools, accessories, available *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

12. Availability of electric energy *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

13. Have you sufficient stock of loan/test weights etc? Give details *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

14. Have you applied previously for a repairer's licence? If so, when and with what results? *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Make Payment

Payment Details

Amount to be paid

Amount *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Reference Number *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Date of Payment *

---pendingNotExist---

---pendingEnd--- ---pendingExist--- ---pendingEnd---