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State of Haryana - Act

Haryana Industrial Promotion Rules, 2007

HARYANA
India

Haryana Industrial Promotion Rules, 2007

Rule HARYANA-INDUSTRIAL-PROMOTION-RULES-2007 of 2007

Published on 6 July 2007
Commenced on 6 July 2007
[This is the version of this document from 6 July 2007.]
[Note: The original publication document is not available and this content could not be verified.]

Haryana Industrial Promotion Rules, 2007Published vide Haryana Government Notification No. 49/43/2007-41B1, dated 6th July, 2007Notification No. 49/43/2007-41B1. - In exercise of the powers conferred by sub-section (1) of section 14 of the Haryana Industrial Promotion Act, 2005 (6 of2006), the Governor of Haryana hereby makes the following rules providing single point time bound clearances required for and operation of industrial undertakings in the State of Haryana namely:

1. Short Title and Commencement.

(1)These rules maybe called the Haryana Industrial Promotion Rules, 2007.

(2)They shall come into force on date of their publication in the Official Gazette.

2. Definitions.

- In these rules, unless the context otherwise requires:-

(a)"Act" means the Haryana Industrial Promotion Act, 2005 (6 of 2006).

(b)"Composite Application Forms" means forms referred to in section 8 duly filled and completed in all respects;

(c)"Form" means a form appended to these rules;

(d)"section" means a section of the Act; and

(e)"undertaking" means an undertaking given by an entrepreneur from time to time under section 10.

3. Composition of High Powered Clearance Committee. Section 3.

- The High Powered Clearance Committee shall consist of the following members, namely:-

(1)	Principal Secretary to Chief Minister, Haryana	:	Chairman
(2)	Principal Secretary to Government, Haryana	:	Member
	Excise and Taxation Department
(3)	Principal Secretary to Government, Haryana	:	Member
	Power Department
(4)	Principal Secretary to Government, Haryana	:	Member
	Town and Country Planning Department
(5)	Principal Secretary to Government, Haryana	:	Member
	Industries Department
(6)	Principal Secretary to Government, Haryana	:	Member
	Labour Department
(7)	Principal Secretary to Government, Haryana	:	Member
	Environment Department
(8)	Director of Industries, Haryana	:	Member Secretary

4. Meeting of High Powered Clearance Committee. Section 3.

(1)The High Powered Clearance Committee shall meet at least once in a month at Chandigarh or at such other place as the Chairman may specify from time to time to transact its business.

(2)Details of all the Composite Application Forms received from entrepreneurs at least fifteen days prior to the ensuing meeting shall be placed before the Committee.

(3)The Member Secretary shall by issuing a meeting notice, convene a meeting of High Powered Clearance Committee indicating the date, time and place of the meeting. He shall enclose agenda and notes highlighting therein details of the applications cleared, applications cleared with modifications, rejected, information regarding the date on which application has deemed to have been approved in the case of deemed approvals and other observations, if any received from the authority for the transaction of business in the said meeting. He shall send a notice of meeting at least seven days in advance.

(4)Member Secretary shall also send communication intimating the date, time and place of the High Powered Clearance Committee meeting to the entrepreneurs, whose cases are included in the agenda.

(5)All the members and invitees of the High Powered Clearance Committee shall attend the meeting in person. In case the member is pre-occupied with other important engagements or business, he shall depute the senior most officer to attend the meeting on his/her behalf with full briefing of the departmental views.

(6)The High Powered Clearance Committee shall examine all the proposals placed before it and take appropriate decisions.

(7)The Member Secretary of the Committee shall within three days circulate the proceedings of the meeting approval of the Chairman.

(8)Within two days of circulation of the proceedings of the meeting, the Member Secretary shall communicate the decision of the Committee to the authorities and the entrepreneur concerned.

(9)The authority shall grant or issue the necessary clearances within three days of the receipt of orders of the Committee.

5. Composition of State Level Clearance Committee. Section 4.

- State Level Clearance Committee shall consist of the following members, namely:-

(1)	Principal Secretary to Government, Haryana	:	Chairman
	Industries Department.
(2)	Principal Secretary to Government, Haryana	:	Member
	Power Department
(3)	Principal Secretary to Government, Haryana	:	Member
	Excise and Taxation Department
(4)	Principal Secretary to Government, Haryana	:	Member
	Town and Country Planning Department
(5)	Principal Secretary to Government, Haryana	:	Member
	Labour Department
(6)	Principal Secretary to Government, Haryana	:	Member
	Environment Department
(7)	Director of Industries, Haryana	:	Member-Secretary

6. Meeting of State Level Clearance Committee. Section 4.

(1)The State Level Clearance Committee shall meet at least once in a month at Chandigarh or at such other place as the Chairman may specify from time to time to transact its business.

(2)Details of the Composite Application Forms received from entrepreneurs at least fifteen days prior to the ensuing meeting shall be placed before the Committee.

(3)The Member Secretary shall by issuing a meeting notice, convene a meeting of State Level Clearance Committee indicating the date, time and place of the meeting. He shall enclose and notes highlighting therein details of the applications cleared, applications cleared with modifications, rejected, information regarding the date on which application has deemed to have been approved in the case of deemed approvals and other observations, if any, received from the authority for the transaction of business in the said meeting. He shall send a notice of meeting at least seven days in advance.

(4)Member Secretary shall also send communication intimating date, time and place of the meeting to the entrepreneurs, whose cases are included in the agenda.

(5)All the members and invitees of the State Level Clearance Committee shall attend the meeting in person. In case the member is pre-occupied with other important engagements or business, he shall depute the senior most officer to attend the meeting on this behalf with full briefing of the departmental views.

(6)The State Level Clearance Committee shall examine all the proposals placed before it and take appropriate decisions.

(7)The Member- Secretary of the Committee shall within three days circulate the proceeding of the meeting after taking approval of the Chairman.

(8)Within two days of circulation of the proceedings of the meeting the Member-Secretary shall communicate the decision of the Committee to the authorities and the entrepreneur concerned.

(9)The authority shall grant or issue the necessary clearances within three days of receipt of order of the Committee.

7. Composition of District Level Clearance Committee. Section 5.

(1)The District Level Clearance Committee shall consist of following members, namely:-

(a)	Deputy Commissioner of the District concerned	:	Chairman
(b)	Executive Engineer, Uttar Haryana Bijli VitranNigam/Dakshin Haryana Bijli Vitran Nigam	:	Member
(c)	Deputy Excise and Taxation Commissioner	:	Member
(d)	District Town Planner	:	Member
(e)	District Level Officer of the Haryana State	:	Member
(f)	Assistant Director Industrial Safety c/o LabourCommissioner-cum-Chief Inspector of Factories	:	Member
(g)	General Manager, District Industries Center	:	Member Secretary

(2)Chairman can invite any other members if deemed necessary.

8. Meeting of District Level Clearance Committee etc. Section 5.

- (l)The District Level Clearance Committee shall meet at least once on a month at district headquarter or at such other place as the Chairman may specify from time to time to transact its business.

(2)Details of all the Composite Application Forms received from entrepreneurs at first fifteen days prior to the ensuing meeting shall be placed before the Committee.

(3)The Member Secretary shall by issuing a meeting notice, convene a meeting of District Level Clearance Committee indicating the date, time and place of the meeting. He shall enclose agenda and notes highlighting therein details of the applications cleared, applications cleared with modifications, rejected, information regarding the date on which application has deemed to have been approved in the case of deemed approvals and other observations, if any, received from the authority for the transaction of business in the said meeting. He shall send a notice of meeting at least seven days in advance.

(4)Member-Secretary shall also send communication intimating the date, time and place of the entrepreneurs, whose cases are included in the agenda.

(5)All the members and invitees of the District Level Clearance Committee shall attend the meeting in person.

(6)The District Level Clearance Committee shall examine all the proposals placed before it and take appropriate decisions.

(7)The Member-Secretary of the Committee shall within three days circulate the proceedings of the meeting after taking approval of the Chairman.

9. Composite Application Form. Sections 8 and 10.

(1)Every applicant seeking to apply for clearance(s) required for establishment or operation of an industry shall apply to the nodal agency in the relevant part(s) of the Form-I or Form-II of the Composite Application Form in Schedule-I. Where the clearance(s) is not covered by the composite application form the applicant shall file additional form or forms, as the case may be, which shall become part of the composite application form. The application shall be accompanied by requisite fee. The latest fee/tariff structure is given at point 8 of instructions to fill up composite application form and Annexures A, B, C and D of Schedule-I.

(2)Form-1 comprises of the following parts:

(i)Common Sheet.

(ii)Part A-Additional information required for obtaining change of land use certificate from Haryana Pollution Control Board.

(iii)Part B-Additional information required for obtaining change of land use certificate from Town and Country Planning Department.

(iv)Part C-Additional information required for approval of Factory/Building Plan under the Factories Act, 1948 (Act 63 of 1948).

(v)Part D-Additional information required for approval of building plan from Town and Country Planning Department.

(vi)Part E-Application and agreement form for release of electric connection from Dakshin Haryana Bijli Vitran Nigam/Uttar Haryana Bijli Vitran Nigam.

(3)Form II comprises of the following parts:-

(i)Part A-Additional information required for Consent from the Haryana Pollution Control Board under the Pollution Control Acts.

(ii)Part B-License from Chief Inspector of Factories under the Factories Act, 1948 (Act 63 of 1948).

(4)The Composite Application Form duly filled in shall be submitted in required member of copies alongwith relevant enclosures, certificate, fees receipts and attachments.

(5)All applicant's shall furnish an undertaking as prescribed in Schedule-II alongwith Composite Application Forms as required under section 10.

(6)The Nodal Agency shall issue the acknowledgement in Schedule-III.

(7)There shall be a check list appended of Form-I and Form-II which shall be completed and signed by the applicant and scrutinized and accepted by the authorized representative of the nodal agency before issuing the acknowledgement.

(8)Before issuing acknowledgement, the authorized representative of the nodal agency shall allot an Identity Number on the Composite Application Form and ensure that:

(i)the application is complete in all respects;

(ii)required number of copies of application have been submitted;

(iii)all relevant and prescribed documents have been enclosed;

(iv)the prescribed fees receipts have been enclosed;

(v)undertaking has been furnished by the applicant;

(vi)the check list has been filed correctly and signed by the applicant.

10. Processing and Monitoring of Composite Application Forms. Section.

(1)Immediately after issue of acknowledgement the particulars of the application shall be entered in the register of applications by the authorized representative of the nodal agency.

(2)The register of application shall be scrutinized and approved by the Head of the Nodal Agency at the end of each working day.

(3)The relevant parts of the Composite Application Forms shall be served on the authority within three working days from the date of filing and a receipt with date shall be obtained from the authority.

(4)The authority shall process the application and send its orders sanctioning or meeting the application, as the case may be, to the nodal agency so that the same can be given by the applicant.

(5)Under the provisions of clause (c) of section 9, the authority may ask for additional information from the applicant one before the expiry of the time limit, under intimation to the nodal agency.

(6)In the case covered under sub-rule (5) of this rule, the time limit shall be palpable from the date the additional information has been furnished.

(7)If the application is rejected or approved with modifications, the Committee in terms of sub-section (f) of section 9 shall examine such orders passed by the authority and if the Committee considers that there are valid grounds for a change in such decision, it shall take a decision which shall be binding on the authority.

(8)In case of applications (except those where provision of deemed clearances apply pending with authorities concerned beyond the time limit) the Committee shall examine all such applications and pass orders which shall be binding on the authorities.

11. Time Limits for Processing and Disposal of Composite Application Forms. Section 9.

- The time limits for processing and disposal of Composite Application Forms by the authority under the provisions of clause (b) of section 9, shall be as indicated in Schedule IV.

12. [ Notifying of clearance where the provision of deemed approval shall apply. Section 11. [Substituted by Haryana Government Gaztte Notification No. S.O.50/H.A.6/2006/S.14/2009 dated 8.6.2009.]

- The provision of deemed approval under sub-section (1) of section 11 shall be applicable to the clearances as indicated in Schedule-V. In case the competent authority fails to issue change of land use certificate within the time frame stipulated in schedule five, the nodal agency, on the recommendation of concerned Clearance Committee, shall refer the matter to the Secretary to Government, Haryana, Town and Country Planning Department for the grant of necessary approval.]

13. Appeal Section. Section 6.

(1)An appeal shall lie:

(i)to the High Powered Clearance Committee against the decision of the State Level Clearance Committee.

(ii)to the Clearance Committee against the decision of the District Level Clearance Committee.

(2)Every appeal shall be accompanied by a fee of five hundred rupees payable in cash. The appeal shall be presented either in person or by an agent duly authorized.

(3)The appellate authority shall, after giving a reasonable opportunity of being to the appellant, pass such order, as it deems fit. The orders of the appellate authority shall be final.

(4)Every order passed by the appellate authority shall be communicated to the appellant within a period of fifteen days from the date of the order.

I

Composite Application Form (CAF)For Obtaining Required Clearances from Authorities Concerned[See rule 9(1)]ID NO. _______________(to be allotted by Investment Promotion Centre/District Industries Centre)Instructions to fill up Composite Application Form

1. Composite Application Form consists of following forms :-

Form I (for establishment)

(i)Common Sheet

(ii)Part A-Additional information required for obtaining no objection certificate from the Haryana Pollution Control Board.

(iii)Part B-Additional information required for obtaining change of land use certificate from Town and Country Planning Department.

(iv)Part C-Additional information required for approval of Factory/Building Plan under the Factories Act, 1948 (Act 63 of 1948).

(v)Part D-Additional information required for approval of building plan from Town and Country Planning Department

(vi)Part E-Application and agreement form for release of electric connection from Dakshin Haryana Bijli Vitran Nigam/Uttar Haryana Bijli Vitran Nigam.

Form II (for operation)

(i)Common Sheet.

(ii)Part A-Additional information required for consent from Haryana Pollution Control Board under Pollution Control Acts.

(iii)Part B-Licence from Chief Inspector of Factories under the Factories Act, 1948 (Act 63 of 1948).

2. Nodal Agency Investment Promotion Centre/District Industries Centre is the first contact point for the entrepreneurs/investors.

3. Entrepreneurs/investors may discuss with the Nodal Agency and avail the assistance to identify a suitable land/shed/location and to know the procedure and formalities to be followed for implementation of their project and to fill up the Composite Application Form.

4. Nodal Agency shall issue a set of Composite Application Form to the entrepreneurs/investors.

5. Information sought for in Composite Application Form shall be filled in block letters, leaving no para blank.

6. Required number of copies of Composite Application Form can be taken by photocopying but signature shall be affixed on each copy in ink. Please ensure legibility and use only A-4 size for photocopying.

7. Entrepreneurs are required to submit required sets of Composite Application Form to the Nodal Agency along with the required fees by way of demand drafts and other enclosures authority-wise.

8. The latest fee/tariff structure as obtained from the authorities concerned is as under:

Required clearances and authorities concerned	Fees
No Objection Certificate/Consent fee fromHaryana Pollution Control Board under Pollution Control Acts.	As per Annexure A
Change of Land Use from Town and CountryPlanning Department	Change of Land Use charges as per Annexure Bplus scrutiny charges @ Rs.2/- per square meter
Approval of building plans from Town and CountryPlanning Department	Rs. 10/- per square meter of the covered area
Licence from Chief Inspector of Factories underthe Factories Act, 1948 (Act 63 of 1948).	As per Annexure C
Uttar Haryana Bijli Vitran Nigam/Dakshin HaryanaBijli Vitran Nigam	As per Annexure D

9. The Nodal Agency shall receive the Composite Application Form after proper scrutiny and issue the acknowledgement.

Annexure-ANOC/Consent Fees under Water Act and Air Act[See rule 9 (I)]

		NOC	19 Category	17 Category
S.No.	Consent Fees	NOC A-I	NOC Highly Polluting A-II	1st year Consent B-I(i)	Subsequent year B-I(ii)	Highly Polluting 1st year B-II	(i) Highly Polluting Subsequent year B-II(ii)
(a)	Industries having capital investment exceedingRs. 100 Cr.	35,000	1,05,000	50,000	25,000	1,50,000	75,000
(b)	Industries having capital investment exceedingRs. 50 crores but not exceeding Rs. 100 crores	20,000	60,000	40,000	20,000	1,20,000	60,000
(c)	Industries having capital investment exceedingRs. 10 crores but not exceeding Rs. 50 crores	12,000	36,000	30,000	15,000	90,000	45,000
(d)	Industries having capital investment exceedingRs. 3 crores but not exceeding Rs. 10 crores	8,000	24,000	20,000	8,000	60,000	24,000
(e)	Industries having capital investment exceedingRs. 1 crore but not exceeding Rs. 3 crores	5,700	17,700	10,000	3,700	30,000	11,000
(f)	Industries having capital investment exceedingRs. 0.50 crore but not exceeding Rs. 1 crore	4,500	14,500	5,000	1,500	15,000	4,500
(g)	Industries having capital investment exceedingRs. 0.25 crore but not exceeding Rs. 0.50 crore	2,500	7,500	2,000	1,000	6,000	3,000
(h)	Industries having capital investment exceedingRs. 0.10 crore but not exceeding Rs. 0.25 crore	1,500	4,500	500	500	1,500	1,500
(i)	Industries having capital investment exceedingRs. 0.02 crore but not exceeding Rs. 0.10 Cr	750	2,250	200	500 Water Act 200 Air Act	600	600
(j)	Industries having capital investment upto Rs.0.02 crore	200	600	100	200 Water Act 100 Air Act	300	300

Annexure-BRates of Conversion Charges in the Controlled Areas in the State(rates rupees per square meter)[See rule 9 (I)]

Potential Zone	Hyper Potential	High Potential	Medium Potential	Low Potential
Name of controlled area	Controlled areas declared under section 4(1)(a)Punjab Scheduled Roads and Control Areas Restriction ofUnregulated Development Act, 1963 (Punjab Act 41 of 1963) aroundMunicipal Town, Gurgaon	Controlled areas declared under section 4(1)(b)Punjab Scheduled Roads and Control Areas Restriction ofUnregulated Development Act, 1963 (Punjab Act 41 of 1963) inGurgaon district including controlled Areas around Sohna town,controlled areas of Faridabad, Ballabgarh Complex, controlledareas of Sonipat-Kundli multifunctional urban complex Panipat andperiphery controlled area of Panchkula.	Controlled areas around towns i.e. Karnal,Kurukshetra, Ambala City, Ambala Cantt. Yamuna Nagar,Jagadhri, Bahadurgarh, Hisar, Rohtak, Rewari,Bawal,Dharuhera Complex,Ganaur, Palwal, Hodel, controlledareas declared under section 4(1)(b) Punjab Scheduled Roads andControl Areas Restriction of Unregulated Development Act, 1963(Punjab Act 41 of 1963) in Faridabad District, Oil refinery,Panipat (Beholi)	All other controlled areas declared in the State
	Abutting on	Abutting on	Abutting on	Abutting on

Use	NH	SR/Sector Road	Other Road	NH	SR/Sector Road	Other Road	NH	SR/Sector Road	Other Road	NH	SR/Sector Road	Other Road
Residential	200	150	100	50	120	100	100	80	60	30	20	15
Commercial	1400	1200	1000	200	1000	400	700	600	350	200	150	100
Industrial	20	20	20	2	12	12	6	6	6	3	3	3
Instiutional	150	120	100	00	80	60	60	40	30	20	15	10
Recreational	20	20	20	2	12	12	6	6	6	3	3	3

Note:- 1. Abbreviation used indicate NH: National Highway; SR.: Scheduled Road.

2. Sector road is the sector dividing road as indicated on the Development Plan.

3. Where a piece of land falls in more than one category, the higher/highest rate shall apply.

Annexure-CLicense fee per Year under Factories Act, 1948[See rule 9 (1)]

Maximum number of workers to be employed onany day during the year
	Upto 20	From 21 to 50	From 51 to 100	From 101 to 250	From 251 to 500	From 501 to 750	From 751 to	Above 1000
Without Horse Power	Rs. 200	Rs. 400	Rs. 600	Rs. 800	Rs. 1000	Rs. 2000	Rs. 3000	Rs. 4000
Not exceeding 10	400	600	800	1000	2000	3000	4000	5000
Exceeding 10 but 50	600	800	1000	2000	3000	4000	5000	6000
Exceeding 50 but 100	800	1000	2000	3000	4000	5000	6000	8000
Exceeding 100 but 250	1000	1500	2500	4000	5000	6000	8000	10000
Exceeding 250 but 500	1500	2000	3000	5000	6000	8000	10000	12000
Exceeding 500 but 1000	2000	3000	4000	6000	8000	10000	12000	14000
Exceeding 1000	3000	4000	6000	8000	10000	12000	14000	16000

Uttar Haryana Bijli Vitran Nigam Ltd./Dakshin Haryana Bijli Vitran Nigam Ltd.[See rule 9 (I)]

	Description		Fees
(i)	Application for Processing charges	(i)	Rs. 25/- per Kilo Watt or part thereof subjectto maximum of Rs. 10000/-
(ii)	Advance Consumption deposit
	(a)	LT industrial supply		Rs.500/- per Kilo Watt or part thereof of theconnected load.
	(b)	HT Industrial supply		Rs.500/- per Kilo Watt or part thereof of theconnected load
(iii)	Meter Security Charges (if applicable)
	(a)	Single phase Meter		Rs.600/-
	(b)	Three phase		Rs.1000/-
	(c)	LT Three Phase meter with CTs		Rs.7500/-
	(d)	HT meter without trivector meter with CTs/PT		Rs.25000/-
	(e)	LT Conventional trivector meter with CTs/PT		Rs.25000/-
	(f)	HT Conventional trivector meter with CTs/PT		Rs.35000/-
	(g)	HT electronic meter with CTs/PT		Rs.40000/-
(iv)	Meter Inspection and Testing Charges (ifapplicable)
	(a)	Single phase		Rs.25/- per meter
	(b)	3 Phase whole current i.e. without C.T.		Rs.50/- per meter
	(c)	L.T. meter with CTs		Rs.250/- per meter
	(d)	H.T.& E.H. metering equipment		Rs.500/- per meter
(v)	Service Connection Charges
	(a)	Single phase NDS		Rs.350/- per Kilo Watt
	(b)	Three phase NDS		Rs.750/- per Kilo Watt
	(c)	Bulk supply and L.T. Industrial Supply		Rs.500/- per Kilo Watt
	(d)	H.T Industrial Supply		Rs.750/- per KVA of contract demand

Form-I[See rule 9(1)]I.D. No._______________Common Sheet[See rule 9(2) (i)]

1. Name and Address of The Promoter/industrialUndertaking (Block Letters)

Name of the Industrial undertaking

|-| {||-|||||||||||||||||||||}|-| Name of thepromoter/Managing Director/Managing Partner with surname first|-| {||-|||||||||||||||||||||}|-| {||-|||||||||||||||||||||}|-| 2. Address forcommunication|-| {||-|||||||||||||||||||||}|-| {||-|||||||||||||||||||||}|-| {||-|||||||||||||||||||||}|-| Tel:| {||-|||||||||||}| Pin Code| {||-|||||||||||}|-| Fax:| {||-|||||||||||}| E-mail| {||-|||||||||||}|-| 3. Constitution ofthe Firm/company :| Proprietorship/Partnership/Pvt.Ltd./Public Ltd./others if any|-| 4. Location:| {||-||||||||||||||||||||}|-| Place/Town| {||-||||||||||||||||||||}|-| Tehsil/Taluk| {||-||||||||||||||||||||}|-| District :| {||-||||||||||||||||||||}|-| State :| {||-||||||||||||||||||||}|-| 5. Main items ofmanufacture/ activity.|-| {||-| S.No| Products/Services| Installed capacity (per annum)|-| 1.|||-| 2.|||-| 3.|||-| 4.|||-| 5.|||}|-| 6. Cost of theProject (Rs. in lacs)|-| 7. Investment inFixed assets (Rs. in 000)|-| (i) Land| {||-|||||||||||}|-| (ii) Building| {||-|||||||||||}|-| (iii) Plant and Machinery| {||-|||||||||||}|-| (iv) Other fixed assets| {||-|||||||||||}|-| Total| {||-|||||||||||}|-| 8. Power requirement|-| Kilo Watt| {||-|||||||||||}|-| 9. Water requirementper day :| Kilo Litres| {||-|||||||||||}|-| (i) For process and Wash||-| (ii) For Cooling||-| (iii) Sanitary||-| (iv) Total||-| 10. ProposedEmployment| {||-||||||}|-| 11. Estimated Date ofcommencement of production| {||-|||||||||||}|}Part-A[See rule 9(2)(ii)]Additional Information Required for Obtaining No Objection Certificate (N.O.C.) From Haryana State Pollution Control Board

1. Details of production and process

1.1

(i)List the main products which are proposed to be produced

(ii)Designed daily capacity

(a)___________________________________________________________

(b)___________________________________________________________

(c)___________________________________________________________

1.2List all Raw Materials with the daily consumption at full production capacity

(a)___________________________________________________________

(b)___________________________________________________________

(c)___________________________________________________________

2. Manufacturing Process_________________________________________

3. Number of persons likely to work in unit___________________________

4. Location

4.1Where it is proposed to locate the unit (Industrial Area or otherwise)______

4.2If the site is situated in notified industrial estate :

(a)	Whether effluent collection, treatment anddisposal system has been provided by the authority;	Yes/No
(b)	Will the applicant utilize the system, ifprovided;	Yes/No
(c)	If not provided, details of proposedarrangement for the treatment of effluent	Yes/No

4.3If not located in Industrial Area then give identification of nearest Residential Area (Such as Village, Town etc.)

4.4Total plot Area, Built up area and area available for the use of treated sewage/trade effluent.________________________________________________

4.5Area proposed to be developed._________________________________

4.6If the site is located near river bank/other water bodies; indicate the name and distance of water body____________________

4.7 Does the location satisfy the requirementsunder Relevant Central/State Government notifications	Yes/No
4.8 Month and Year of proposed commissioning ofthe unit.	Month___________
	Year ____________

5. Average Daily quantities of water to be consumed (in Kilo litre/daily): Proposed

(i)Process and wash ____________________________________________

(ii)Cooling____________________________________________________

(iii)Sanitation/Domestic/Horticulture_______________________________

(iv)Total______________________________________________________

6. Waste Water discharge per day from: 6.1 Waste Water discharge per day from:

(i) For process and Wash

(ii) Cooling

(iii) Sanitary

(iv) Total

7. Proposed Effluent Treatment Scheme

Stack/source of emission :	1	2	3	4
(i) Total Number
(ii) Source
(iii) Height in m. above G.L.
(iv) Height in m. above top of building
(v) Internal Diameter in mm.

9. Proposed Air Pollution control System
Give information on type and add detailed specifications
		Collectors	Precipitators	Scrubbers
	(1)
	(2)
	(3)
	(4)
10. Proposed method of handling and disposal ofwaste trapped by pollution arresting equipment/Hazardous Waste.
	Landfill		Dumping		Incinerators
	ADD separate sheets wherever necessary
	Place______________________Signature______________________
	Date______________________Name__________________________
	Desgination_______________________________________________
	Address__________________________________________________
	* Annexures to be attached as per Check List
	Signature of applicant (Authorised Person)

Part-B[See rule 9(2) (iii)]I.D.No.___________________Additional Information Required for Obtaining Change of Land use (C.L.U.) From Town and Country Planning DepartmentToThe Director,Town and Country Planning Department,Haryana, Chandigarh.Controlled Area______________________________________________Sir,I/We beg to apply for permission to change the existing use of land for the purpose of developing the land into building for industrial purpose.I/We enclose the following documents in triplicate:

1. A survey of the land on the scale 1 inch to 40 feet showing the existing means of access of the said land.

2. Copy of the deed showing the title of land in favour of applicant.

3. Copy of Small Scale Industry registration certificate.

4. Copy of the project report.

5. Copy of Fard Jamabandi, Aksh sajra, mutations etc.

6. Copy of site plan and land utilization plan.

7. Scrutiny fee of Rs.2/- per square meter.

Dated:Yours faithfully,Name and full addressPart-C[See rule 9(2)(iv)]I.D. No.______________Additional Information Required for Obtaining Permission to Construct, Extend or take into use any building as a Factory under Factories Act, 1948

1. Particulars of plant to be installed

____________________________________________________________________________________________________________________________________________________________________________________Annexures to be attached:

1. A flow chart of the manufacturing process supplemented by a brief description of the process in its various stages.

2. Plans, in triplicate drawn to scale, showing:

(a)The site of the factory and immediate surroundings including adjacent building and other structures, roads, drains etc; and

(b)The plan elevation and necessary cross-sections of the various buildings indicating all relevant details relating to natural lighting, ventilation and means of escape in case of fire. The plans shall also clearly indicate the position of the plant and machinery, aisles and passage ways; etc.

Form No. 1 A(Part C)Name of the Factory..................................Particulars of Rooms in the Factory

Name of the Rooms in Factory	Length	Breadth	Dimention in feetHeight	Breathing space (contents in cubic feet)	Total volume of air in the room
			Max	Min	Average	Total area in Square feet.	Floor Area Occupied by Machinery in the room

Ventilation	Maximum number of persons intended to beemployed in the room	Whether the room is to be used as work room orstorage room	Date of construction	Remarks
Number and size of the	Number and size of window doors	Total area in square	Maximum capacity of the opening feet room

Signature of the Occupier_________________Signature of the Manager__________________Questionnaire Annexed To Form No. 1A(Part C)

1. (a) Is the Form No.lA submitted filled in for all work-rooms, godowns, etc., which are proposed to be constructed or extended?

(b)Is the sectional elevation of each room or shed etc., shown separately?

(c)Is the minimum height of every room, shed, etc., shown clearly in sectional elevation?

(d)Is the material of which the roof is constructed indicated in the sectional elevation?

(e)Are the positions of various machines fitted or proposed to be fitted, shown in the drawings together with their names?

(f)Are the minimum number of persons working or proposed to be working in different rooms, sheds etc., mentioned in the drawing?

(g)Are all new buildings, parts of buildings or alterations in existing building shown by the boundaries duly marked by a distinctive colour?

2. Form No.1-A. Is the breathing space of a work-room, sheds, etc., calculated as shown below?

(a)Floor area of a room multiplied by height of the room (the maximum height for calculation, should not exceed 14 feet).

(b)Is the maximum of persons shown, as the lower value of the two calculations? as shown below?

(i)Floor area of a room less area occupied by machinery in the room divided by 36.

(ii)Breathing space as in (a) above divided by 500.

(c)Is the window and skylight area provided at the minimum area of 1 square feet to every 6.66 square feet of floor area of room? (It is recommended that window and skylight may be provided one opposite another so as to provide best cross-ventilation)

3. Doors:

(a)Is every work-room provided with at least two doors?

(b)Is the minimum size of every door 6.-6"X3.-3"?

(c)Are all the doors opening outwards?

4. Fire Escapes. If any factory building is of more than one storey:

(a)Are two fire-escapes provided on either side of building?

(b)Are the fire-escapes accessible from every room in the building?

(c)Is the material used in construction of the fire-escape non-contributible?

(d)Are the windows or doors giving access to an external staircase arranged to open immediately from inside?

5. Latrines and Urinals:

(a)Are the latrines and urinals provided separately?

(b)Are these sufficient to meet the requirements of section 19 of the Factories Act, 1948 (Act 63 of 1948) read with rules 42 and 47 of the Factories Act, 1948 (Act 63 of 1948)?

(c)Is the minimum distance of the nearest building shown?

(d)Is the minimum distance of the nearest well shown?

(e)Is the surrounding ground upto a distance of 4 feet all round made of impermeable material?

(f)Is the surrounding ground raised to at least six inches above ground level?

(g)Is any latrine, ventilator or opening in the proximity of any opening of main building?

(h)Are these latrines flush type?

(i)Are all the drains, pipes, sewers for carrying sullage, sewage water, effluent and waste products running in factory premises constructed of impermeable material?

(j)Are the drains of flush-type latrine connected to drainage system of the Local Board?

(k)Is an efficient system of sceptic tanks provided, if no drainage system exists?

(l)Are the latrines provided with roofing?

6. Drinking Water

(a)Is the drinking water provided from a source provided by local board? [If not, whether the source from which the drinking water is supplied, has been approved by the Deputy Chief Medical Officer, Health or any of the laboratories recognized by the Water Pollution Board, Haryana or the State Public Health Authorities]

(b)Is any well constructed in the premises of the factory for drinking water of humidification purpose?

(c)Is the cylinder of the well pucca and impervious to water throughout and upto depth not less than the lower level of sub-soil water.

(d)Are the positions of water centers shown in the plans?

7. After showing the above details, the plan, site plan, this questionnaire and Form No. 1-A should be submitted in triplicate direct to the Chief Inspector of Factories, Haryana for approval.

8. A certificate of stability signed by a person having the qualification laid down under rules shall be submitted on Form No. 1 -B before the manufacturing process with the aid of power is begun in the building.

Signature_____________________________________Designation___________________________________Date_________________________________________Form No. 1B(Part C)Plan and SpecificationCertificate of stability of a factory or part of a factory.(To be submitted after completion and before working)["I hereby declare that I have personally inspected the spot, examined the plans and specifications of the building described below, the heights of the roofs, the actual materials and methods used in its construction and the finished building and satisfied that its construction when used as a factory for the purpose herein declared and the heights of the roofs conform to the heights shown in the plans."]Description of Building

1. Name of the factory__________________________________________

2. Name of the builder or contractor (s)_____________________________

3. General type of construction____________________________________

(a)Full name of signatory (in block letters)_______________________

(b)Qualifications____________________________________________

(c)Present occupation________________________________________

(d)Permanent postal address___________________________________

4. Purpose for which the building is to be used_______________________

5. Name of room or building for which the certificate is granted giving reference to plan No._____________________________________________________

6. Nature of work to be carried on in the above room/building.

7. Nature and amount of moving power_____________________________

8. Signature___________________________________________________

9. Date_______________________________________________________

Note: - The person competent to give the certificate of stability shall possess -

(i)degree in Civil or Structural Engineering or equivalent;

(ii)a minimum of ten years experience in the design or construction or testing or repair of structure;

(iii)knowledge of Non-destructive testing, various codes of practices that are current and the effect of the vibration and natural forces on the stability of the building; and

(iv)ability to arrive at a reliable conclusion with regard to the safety of the structure of the building.

Part-D[See rule 9(2) (v)]I.D. No.__________________Additional Information Required For Permission From Town and Country Planning Department To Erect A Building For IndustryToThe Director,Town & Country Planning,Haryana, ChandigarhSir,I/We apply for permission to erect/re-erect/add to alter a building/wall in accordance with the plans submitted herewith on the site No.____________ Street___________at______________.I/We attach:

(a)a site plan in triplicate showing the position of the site proposed to be built upon as required by the rules.

(b)plans, elevations and sections in triplicate as required by the rules.

(c)drainage plans, engineering drawings (structural)in triplicate as required by the rules; and

(d)specifications of the proposed building (in triplicate; and)

(e)demand draft as prescribed under the rules-Rs 10/- per sq.mtr. address to Director, Town & Country Planning, Haryana payable at Chandigarh.

The construction of the building will be supervised by_________________Supervisor-cum-architect.Signature of applicantSpecifications(PART-D)The materials to be used in the construction to be clearly specified under the following heads :-

Items	Specifications
(a) Foundations
(b) Walls
(c) Damp-proof course
(d) Floors
(e) Roofs
(f) Windows and Doors and other wood work
(g) Steel Work
(h) Internal finish
(i) External finish

Signature
Supervisor-cum-Architect	Signature of applicant

Part-E[See rule 9(2) (vi)]I.D. No.___________Additional Information Required for Release of Electric Connection and Agreement for Industrial SupplyUttar Haryana Bijli Vitran Nigam Ltd/dakshin Haryana Bijli Vitran Nigam LtdApplication and Agreement form in Respect of L.T. Industrial/street Lighting/bulk Supply/public Water Works Supply on lt (Upto 70 Kilo Watt)

(Strike out whichever is not applicable)		Photo
(for office use only)
Name of the Sub-Division__________________________
Application No.__________________________________
Date of Receipt__________________________________

(To be filled up by the applicant in Block Letters in Ink)

1	Applicant's Name
2	Father's name/Husband's name
3	Full Address of the premises at which' supply isrequired.
4	Telephone No. (if any)
5	Permanent Address (Residential)
6	Bank Account No. (if any)
7	Name of the Bank with address
8	Ration Card No./Voter Identity Card No./PanNo./Driving License No.	Any one
9	Details of any other connection in the name ofapplicant (if any)	Category_____________AccountNo.________________Address______________
10	Details of any other connection in the samepremises (if any)
11	If Tenant, Landlord's Name and Address
12	Category of Connection [L.T.Industrial/Street/Bulk Supply(Domestic and Non-Domestic below 70KW), Public Water Works]
13	Type of Industries
	A Seasonal/Non-Seasonal
	B Polluting/Non-Polluting
14	Type of Connection (Temporary or Permanent)
15	Connected Load/Contract Demand, applied for (inKW/KVA) (Furnish details in table at page-4)
16	Voltage at which supply required (LT:3Phase/LT:1 Phase/11 KV)
17	Whether new connection, reconnection,extension/reduction in load or change of name
18	Existing Account No.(if any) (for reconnection,extension/reduction in load or change of name)

Date_________________

Signature of applicant ___________________

Acknowledgement

Date	Applicant's Name	Category of supply	Application Number

(Signature of authorized officer)

Instructions for applicant's:-
(i)	Application No. shall be allotted by the cashierat the time of receipt of application processing charges.
(ii)	Please furnish installation test report issuedby licensed electrical wiring contractor, after completion ofinstallation giving full details of load/machinery.

Declaration(Part-E)I .................................. son/daughter/wife of ............................. resident of ................................. (hereinafter referred as `Applicant', which term shall mean and include executors, administrators, heirs, successors and assignees), do hereby swear and declare as under:ORThe......................................... a company incorporated under the provisions of the Companies Act, 1956 (1 of 1956), a sole proprietorship, a partnership having its registered office at..............................(hereinafter referred to as "Applicant", which expression shall unless repugnant to the context or meaning thereof, include its successors and assignees), do hereby swear and declare as under :

1. That the applicant is a legal occupant/owner/landlord of the premises at................ in support of which the applicant has enclosed a proof of occupancy/ownership.

2. That in case of tenant;

(i)the written consent of the landlord of the applicant's taking of the said supply is enclosed herewith; or

(ii)the applicant is the lawful occupier of the premises, but it has not been possible to obtain consent of landlord and the applicant hereby agrees to keep the supplier indemnified and harmless against all claims made and actions and proceedings initiated by the landlord or any person claiming through or under him by reason of the giving of electric connection by the supplier to the applicant, Indemnity bond duly executed on court paper of Rs.15/- is attached.

3. That the applicant has requested the Uttar Haryana Bijli Vitran Nigam Limited/Dakshin Haryana Bijli Vitran Nigam Limited (hereinafter referred to as the "Supplier") to provide connection in the above mentioned premises in the applicant's name for the purpose mentioned in the application and agreement form.

4. That the applicant hereby further agrees and undertakes as under :

(i)The applicant desires to have and agrees to take Electrical supplies for the purpose stated in the application and agreement from, from the supplier at the premises stated, not exceeding the sanctioned load of the installation.

(ii)To indemnify the supplier against all proceedings, claims, demands, cost, damages, expenses that supplier may incur by reason of a fresh service connection to the applicant.

(iii)That all the electrical work done within its/their premises are as per the provisions of Electricity Act, 2003, and indemnifies supplier against any loss to the applicant accrued on this account. Further applicant agrees that if there is any harm/loss to the property of supplier, due to the fault of the electrical network within the premises of the applicant, all the liabilities shall have to be borne by the applicant. Further, that the lift installed (if applicable) has been inspected and certified by the Lift Inspector and all the fire safety norms have been complied with and the necessary fire clearance certificate (if applicable) has been issued by the competent authority. The applicant indemnifies the supplier against all proceedings, claims, demands, costs, damages, and expenses that suppliers may incur by violation of the regulations.

(iv)To accept and abide by all norms, conditions of supply, including Schedules of tariffs, Schedule of General and Miscellaneous Charges, as per the provisions of the Electricity Act, 2003 and other applicable laws in force, Rules/Regulations/Orders/Directives/Notification issued and endorsed under applicable laws by Haryana Electricity Regulatory Commission/CEA/Government of India/Government of Haryana and any other instructions/circulars issued by supplier/Nigam from time to time for equitable and efficient distribution of electric energy.

(v)To pay for the said supply in accordance with the relevant applicable Schedule of tariffs and also to pay all such other proper charges (including Monthly Minimum Charges, if applicable), as may become due, to the supplier, from time to time at rates laid down in the Standard Schedule of General and Miscellaneous Charges prescribed by the supplier.

(vi)To pay taxes/duties, as may be levied on the sale of electricity to the applicant by the supplier.

(vii)Require the supplier to supply with the necessary meter/meters on hire in terms of section 55 of the Electricity Act, 2003. The applicant agrees to give the supplier such meter security and monthly meters service charges, as may be required for the price of the meter/meters, whenever called upon to do so. In case, meter is not readily available, the applicant may be permitted to arrange own meter of standard specification as approved by the suppliers.

(viii)To be responsible for the safe custody of the meters, CTs, PTs, cables etc. provided by supplier and in case there is any damage of these equipments due to reasons attributable to the applicant, the same shall be chargeable to the applicant. Further all repercussions, on account of breakage of seals of meters etc. direct/dishonest/abstraction of energy shall be to the account of applicant as per the extent rules of supplier.

(ix)To allow clear and un-encumbered access to the meters for the purpose of meter reading and its checking.

(x)That the applicant shall have no objection at any time to the rights of the supplier to supply energy to any other consumer from the service line of apparatus installed on the applicant's premises.

(xi)That the supplier shall not be held responsible for any interruption/diminution of supply beyond its control.

(xii)That the supply shall be used for the purpose that it has been sanctioned by the supplier and shall not be misused in any way to serve any other purpose.

(xiii)That the supply shall not be extended/sublet to any other premises.

(xiv)That the applicant's industry/trade has not been declared to be obnoxious, hazardous/pollutant by any Government agency and that no court orders are being infringed by grant of supplied electricity connection at the applicant's premises.

(xv)That grant of electricity connection will not confer any legal right for regularization of building/land use in respect to the electricity connection provided at the applicant's premises.

(xvi)That the supplier shall be at liberty to adjust the electricity consumption charges along with any other charges against the security deposits paid by the applicant, in the event of termination of agreement or in case of any contractual default.

(xvii)To pay any sum which may be found to become payable to supplier with regard to all liabilities personally as well as by means of both movable and immovable properties.

(xviii)To deposit additional consumption security/ACD as revised by Uttar Haryana Bijli Vitran Nigam/Dakshin Haryana Bijli Vitran Nigam from time to time as per the prevailing regulations of Haryana Electricity Regulatory Commission.

(xix)That the supplier shall be at liberty to transfer the dues remaining unpaid by the applicant to other service connection(s) that may stand in the applicant's name and recover the same against the consumption security/ACD.

(xx)That the applicant would let supplier to disconnect the service connection under reference, in the event of any default, non-compliance of statutory provisions and in the event of legally binding directive by a statutory authority(s) to effect such an order. This shall be without prejudice to any other rights of supplier including that of getting its payment as on the date of connection.

(xxi)The applicant is not a defaulter under the jurisdiction of Uttar Haryana Bijli Vitran Nigam and Dakshin Haryana Bijli Vitran Nigam.

(xxii)There is no outstanding defaulting amount against the premises on which the connection is being sought.

(xxiii)To pay any sum which may be found to become payable to supplier with regards to past dues of suppliers of the above premises.

(xxiv)That the applicant shall abide by the power cut, restricted/peak load hours restrictions imposed by the supplier from time to time.

(xxv)All details furnished in this application and agreement forms are true to the applicant's knowledge. If any information is found incorrect/concealed at a later stage, then the supplier will have the right to withhold/disconnect supply without any notice, as the case may be, and forfeit the securities deposited with the supplier and the supplier will have right to adjust all dues against the security deposits.

The applicant further agrees that this declaration given by him will be construed as an agreement with the (UHBVN/DHBVN)/supplier to the above effect.

Witness Name___________________________		___________________________
Father's Name___________________________		Signature of the applicant
Address________________________________

Account Number __________________ Name of applicant _______________Signature ___________________.List of documents to be attached with A and A Form (if required, specimen of indemnity bond and resolution is available at Sub-Divisional Officer office.

1. Copy of registration deed/Municipal or Panchayat Tax Assessment Notice/Allotment letter by Haryana Urban Development Authority/Haryana State Industrial Development Corporation/Lease Deed/Rent Receipt.

2. Consent of landlord or indemnity Bond if consent of landlord not available in case of tenant seeking connection.

3. General power of attorney in favour of signatory; in case of joint ownership and partnership firms; Certified true copy of the resolution, authorizing the signatory to deal with the Uttar Haryana Bijli Vitran Nigam/Dakshin Haryana Bijli Vitran Nigam, passed by the Board of Directors, in case of companies (as applicable).

4. Self attested photocopy of the partnership deed in case of partnership firms/memorandum and article of association in case of companies, (as applicable).

5. Copy of layout plan of the factory premises showing proposed location of meter & metering equipment i.e. meter and metering equipment should be located in a separate room at the main entrance of the factory premises having direct access from the main road.

6. No objection certificate from Haryana Water and Air Pollution Board (if applicable)

7. Attested copy of any one of documents listed at Serial Number 8 of page 1 of the form.

Uttar Haryana Bijli Vitran Nigam Ltd/dakshin Haryana Bijli Vitran Nigam Ltd(Part-E)For Office use onlyApplication No:_________________________________________applicant's Name:_______________________________________Father's Name:__________________________________________Payment Made With ApplicationAccepted on behalf of the Uttar Haryana Bijli Vitran Nigam Ltd/Dakshin Haryana Bijli Vitran Nigam Limited or connected load of - Kilo Watt At ________________________voltage level under______________category connection. Cashier to accept charges on account of the following :-

Date_________________

Signature_______________________

Sr. No.	Item*	Amount (in Rs.)
1.	Application Processing Fee
2.	Consumption Security
3.	Meter Security (if applicable)
4.	Meter testing fee (if applicable)
5.	Applicable Service connection charges as perHERC Regulation/Orders.
6.	Any other item
	Total

* Strike out whichever is not applicable.Received Rs. ________________ (Rupees___________________________)Vide Receipt No.___________________ Dated _______________________Name______________Designation______________Signature____________Certificate of Site VerificationCertified that I have personally verified the premises of the applicant at his site on which the supply is required.Name of 11 KV feeder___________________________________________Name of Power Transformer______________________________________Name______________Designation_______________Signature__________Date____________No Dues CertificateCertified that nothing is due against the applicant or the premisesName_________________Designation_______________Dated__________Authorization for Connection(Part-E)For Office use onlyAccepted and Sanctioned on behalf of the Uttar Haryana Bijli Vitran Nigam Ltd./Dakshin Haryana Bijli Vitran Nigam Ltd. for connected load of________Kilo Watt at_________voltage Level for_____________category connection.

Dated_____________

SDO 'OP'

The following charges/additional charges, documents and equipment for release of connection as per site verification be accepted:

(A)Charges: -

Sr. No.	Item*	Amount (in Rs.)
1.	Consumption Security
2.	Meter Security (if applicable)
3.	Meter testing fee (if applicable)
4.	Applicable Service connection charges as perHaryana Electricity Regulatory Commission Regulation/Orders.
5.	Any other item

*Notes: - Strike out whichever is notapplicable.
(B) Documents and Equipments
(i) Test Report
(ii) Energy Meter (if applicable)
Dated______________	SDO 'OP’
Received Rs. ________________ (Rupees__________________________)
Vide Receipt No.___________________ Dated _____________________
Name______________Designation______________Signature__________
Received documents and equipments _____________
Name _____________ Designation ____________ Signature____________
The Account number allotted to applicantis___________________________
The service connection order numberis_____________________________
Name ________________Signature______________ Dated __________

Details of Calculation of Load to be Filled by Applicant(Norms may be revised from time to time)

Serial Number	Particulars	No. of points	Total Load (in Kilo Watt)	For office use only
1	Light points (40 watt each)
2	Fan Points (60 watt each)
3	Wall Socket (5 Amp) 6 sockets or part thereof =40 watts)
4	Wall Socket (15A) (6 sockets or part thereof = 1Kilo Watt)
5	Rose outlets for light point
	(i) For DS :- 1 to 5 rose outlets (40 watts); 6to 10 rose outlets (2x40 watts)
	(ii) For NDS : 40 watt for each rose outlet
6	Air-Conditioners through Wall Socket (takeactual load as per capacity)
7	Geysers through wall socket (take actual load asper capacity)
8	Details of industrial load as per format(Annexure-1)
	Total

Annexure IDetails of the industrial load(Part E)

Serial No.	Details of Motors/Equipment	BHP	Load in Kilo Watt	Remarks if any

Application and Agreement Form In Respect of H.T. Industrial/street Lighting/bulk Supply/public Water Works Supply On Ht (Upto 70 Kilo Watt)(Part E)

(Strike out whichever is not applicable)		Photo
(for office use only)
Name of the Sub-Division__________________________
Application No.__________________________________
Date of Receipt__________________________________

(To be filled up by the applicant in Block Letters in Ink)

1	Applicant's Name
2	Father's name/Husband's name
3	Full Address of the premises at which supply isrequired.
4	Telephone No. (if any)
5	Permanent Address (Residential)
6	Bank Account No. (if any)
7	Name of the Bank with address
8	Ration Card No./Voter Identity Card No./PanNo./Driving License No.	Any one
9	Details of any other connection in the name ofapplicant (if any)	Category_______________AccountNo.____________Address________________
10	Details of any other connection in the samepremises (if any)
11	If Tenant, Landlord's Name and Address
12	Category of Connection [H.T.Industrial/Street/Bulk Supply(Domestic and Non-Domestic above 70KW), Railway for Traction Public Water Works]
13	Type of Industries
	A Seasonal/Non-Seasonal
	B Polluting/Non-Polluting
14	Type of Connection (Temporary or Permanent)
15	Connected Load/Contract Demand, applied for (inKW/KVA) (Furnish details in table at page-4)
16	Voltage at which supply required (11 KV, 33 KV,66 KV, 132 KV)
17	Whether new connection, reconnection,extension/reduction in load or change of name
18	Existing Account No.(if any) (for reconnection,extension/reduction in load or change of name)

Date_________________________

Signature of applicant

Acknowledgement

Date	Applicant's Name	Category of supply	Application Number

(Signature of authorized officer)

Instructions for applicant's:-
(i)	Application No. shall be allotted by the cashierat the time of receipt of application processing charges.
(ii)	Please furnish installation Test report issuedby licensed electrical wiring contractor, after completion ofinstallation giving full details of load/machinery.

Declaration(Part E)I.................................son/daughter/wife of..............................................resident of..............................(hereinafter referred as "Applicant", which term shall mean and include executors, administrators, heirs, successors and assignees), do hereby swear and declare as under:ORThe.............................................................................. a company incorporated under the provisions of the Companies Act, 1956 (1 of 1956), a sole proprietorship, a partnership having its registered office at..........................(hereinafter referred to as "Applicant", which expression shall unless repugnant to the context or meaning thereof, include its successors and assignees), do hereby swear and declare as under:-

1. That the applicant is a legal occupant/owner/landlord of the premises at............ in support of which the applicant has enclosed a proof of occupancy/ownership.

2. That in case of tenant :-

(i)the written consent of the landlord of the applicant's taking of the said supply is enclosed herewith; or

(ii)the applicant is the lawful occupier of the premises, but it has not been possible to obtain consent of landlord and the applicant hereby agrees to keep the supplier indemnified and harmless against all claims made and actions and proceedings initiated by the landlord or any person claiming through or under him by reason of the giving of electric connection by the supplier to the applicant. Indemnity bond duly executed on court paper of Rs.15/- is attached.

3. That the applicant has requested the Uttar Haryana Bijli Vitran Nigam Limited/Dakshin Haryana Bijli Vitran Nigam Limited UHBVAN/DHVN (hereinafter referred to as the "Supplier") to provide connection in the above mentioned premises in the applicant's name for the purpose mentioned in the application and agreement form.

4. That the applicant hereby further agrees and undertakes as under:

(ii)To indemnify the supplier against all proceedings, claims, demands, cost, damages, expenses that supplier may incur by reason of a fresh service connection to the applicant.

(vi)To pay taxes/duties, as may be levied on the sale of electricity to the applicant by the supplier.

(viii)To be responsible for the safe custody of the meters, CTs, PTs, cables etc. provided by supplier and in case there is any damage of these equipments due to reasons attributable to the applicant, the same shall be chargeable to the applicant. Further all repercussions, on account of breakage of seals of meters etc. direct//dishonest/abstraction of energy shall be to the account of applicant as per the extent rules of supplier.