Issue to M/S / Sh.…….……………………………………………...... ………WC-…………...... …..………

For Chief Electrical Inspector

FORM “F”

GOVERNMENT OF HIMACHAL PRADESH

Application for ’C’ Class Electrical Contractor’s License (To be filled in English or Hindi)

  1. Full name and address of the applicant/ firm……………………...... ………………………………

……………………………………………………………………………...... ………………………

………………………………………………………...... ………………………………………….

  1. Name of partners, if any………………………...... …………………………………………………

……………………………………………………………………...... ……....……………………….

…………………………………………………………………………...... ………………………….

  1. Details of certificate held by the applicant/or partner………………...... ……………………………

……………………………………………………………...... ……………………………………….

  1. Name and certificate No. of holder or certificate of competency as Electrical Supervisor (No……….….)/ Wireman Permit(No………………) of Electrical Inspectorate of H.P. and /or Degree/Diploma/Certificate in Electrical Engineering from ……………..…………(Name of the Institution), which is recognised by the Central Govt. ………………… State Govt. on the strength of which the Contractor’s License is sought.
  2. Amount of fees deposited Rs. 2500/- for five years (as applicable) Treasury Challan No………Date………………..Name of treasury………………………...………………………………
  3. Three passport size photographs out of which one Noduly attested by a competent authority/Gazetted Officer should be sent alongwith application form.

I/We ……………………………………..………………………………………………………………......

hereby declare that the particulars stated above are correct to the best of my/our knowledge and that I /We fully understand the terms and conditions under which a contractor’s license is granted and that a breach of them will render the license liable to suspension or cancellation.

Dated………………….20Signature of applicant,

Signature of partner.

Note:- Strike-out whichever is not applicable.

Last date for Submission:07/07/2012

GOVERNMENT OF HIMACHAL PRADESH Annexure –I

APPLICATION FORM FOR ENLISTMENT AS AN ELECTRICAL CONTRACTOR FOR CLASSC

1 / Full Name (in Block Letters) ...... / (Photo attested by a Gazetted officer)
2 / Father’s Name ......
3 / Contact No.
a. Landline No. with code:-
b. Mobile No.:-
c. Fax No.:- / …….…………………….……………
………………………………………....
……………………………….…………
4 / Permanent Address / ......
......
......
5 / Address for Correspondence / ......
......
......
6 / Cost of Application Form
( copy of Original Challan to be enclosed) / Original Challan No. ..…………….…
Dated ………………..…………
7 / Date of Birth(Authentic proof of age is to be supplied) / ......
8 / Details of Academic Qualification (Attested copy to be supplied) / ......
9 / Details of Technical Qualification (Attested copy to be supplied)
a. Who himself is a licensed Wireman and have passed I.T.I. in Electrician/Wireman Trade and one year experience after getting Wireman Permit. Or
b. Who himself has passed Matriculation Exam. and have two year experience after obtaining the Wireman Permit(Copy enclosed) / ......
………………………………………….
………………………………………….
10 / Class in which enlistment sought / .. ………………………………………
11 / Whether the applicant has necessary instruments, tools and Books as required under rules of Licensing Board along with original cash vouchers of instruments purchased/held. The detail information may please be supplied on Annexure I (a). / Whether Yes / No
12 / Whether the Affidavit of employee as per specimen Annexure II & III is supplied. / Yes / No
13 / Whether the Affidavit of employer as per specimen Annexure IV is supplied. / Yes / No
14 / Whether the Affidavit of the Immoveable property as per specimen Annexure V is supplied. / Yes / No
15 / i)In case of Firm/Company/Society, submit attested copy of Registration.
ii) The power of attorney to whom the Firm has given signatory Authority to sign the License papers in the jurisdiction of Himachal Pradesh with the proof on Indian Nationality. / Yes / No
16 / Original Character Verification Certificate as per specimen enclosed (see Annexure V) / Yes / No
17 / Whether the contractor has read the Rules for enlistment of contractor and is prepared to abide by them. / Yes / No
18 / Whether three recent passport size photographs out of which one photograph to be got attested from the front to be attested by a Gazetted officer of each individual contractor, owner of the Firm and Supervisor is to be supplied. / Yes / No
19 / Whether attested three specimen signature by the Gazetted officer of the below mentioned is supplied:
i)Individual Contractor
ii) Person holding the Signatory Authority.
iii)Supervisor / Yes / No
20. / Jurisdiction opted(Write two names of HPSEBL Division) / ………………………………..

CERTIFICATE

  1. I/We certified that I/we will not myself/ourselves registered as contractor in the department under more than one name.
  2. I/we also certify that the proprietor/Director(s) are not dismissed/black list by Government/Semi-Government servant.
  3. I/we undertake not to employ directly or indirectly any person dismissed from Government/Semi-Government device in or business without prior permission of the office.

Dated……………………………………Signature of the applicant:- ……………...………

Full Address:-…………………………. ………………………… ………………………….

Note:-

  1. Eligibility:- ‘C’ Class Electrical Contractor’s license will be granted to such persons who himself is a licensed Wireman and have passed I.T.I. in Electrician/Wireman Trade and have one year experience after getting Wireman Permit. OR

“To such person who himself is a licensed Wireman and have passed Matriculation Examination and have two years experience after obtaining the wireman permit after qualifying the Wireman examination.”

  1. The complete Application Form F and Annexure I to enlist the Contractor will be submitted along with the 2 Nos. self addressed stamped envelops of size 25x12 cm of Rs. 10/- each written with his full correspondence address and Phone No. / Mobile No. with the STD Code.
  2. The application found in order in all respect shall be called to attend the office of Licensing Board-cum- Chief Electrical Inspector, Block No. 29, SDA Complex, Kasumpti-171009(H.P.) on the fixed day 21st of July, 2012. The applicant must be ensured his presence alongwith employed staff to attend this office on the fixed schedule to verify the instruments and Books with original cash memos and original documents (ensure presence of Supervisors and Wiremen Permit Holders with there original certificates and permits)..
  3. The license fee of Rs.2500/- shall be charged from the applicants after the verification of Sr. No. 3 and the eligible candidates documents shall be put up to the Licensing Board for approval please.
  4. The Application Form can only be downloaded from the official website: No Forms can be issued from this office.

ANNEXURE-I(a)

Verification of instruments for the year......

Name of the Contractor......

Class of Contractor......

License No......

Description of Instruments:-To be verified on dated: 21/07/2012

Sr. No. / Name of Instruments / Make / Sr. No. of Instruments / Range / Capacity / In working order/Defective / Original Cash Book No. and date / Remarks
1 / I.S.I. Approved Insulation Tester/ Megger of 500 Volts
2 / One line Tester.
B
1 / Name of Books:
I.S.: 732-1963 Code of practice for electrical wiring installation (System Voltage not exceeding 650 Volts)
2 / I.S. 5216-1969 Guide for safety procedures in Electricity Works.
3 / Indian Electricity Rules, 1956 read with Electricity Rules, 2005.

( Signature of the Contractor)

Date: ……………………………

Checked by...... Counter Signed by:-

Name and Designation...... Chairman/ Secretary Licensing Board,

(Not below the rank of Assistant Electrical Inspector)Block No. 29, SDA Complex, Kasumpti,

...... H.P. Shimla-171009

……………………………………………

Date...... Place......

ANNEXURE-I(b)

STAFF REGISTER TO BE MAINTAINED BY THE ELECTRICAL CONTRACTORS

Name of Contractor...... License No...... To be verified on dated: 21/07/2012

Detail of Wireman Employed
Sr. No / Name of Wireman and full address / Whether self or employed / Wireman Permit No. / Period of validity / Date of appointment / Gross monthly
Salary / Signature of
Wireman / Signature of the proprietor / Remarks
Detail of Apprentices
Sr. No / Name of Apprentices and full address / Whether self or employed / Apprentices Certificate of Competency No. / Period of validity / Date of appointment / Gross monthly
Salary / Signature of Apprentices / Signature of the proprietor / Remarks

ANNEXURE- II

SPECIMEN OF AFFIDAVIT (from staff employed)

On Non-Judicial Paper worth Rs. 3/-

(To be verified and attested by competent authority i.e. Magistrate Ist Class)

I . ______Son of Shri ______Solemnly declare as under:-

That I am technically qualified person possessing Wireman Permit (WMNo.______) of Electrical Inspectorate of Himachal Pradesh.

That in the event of my accepting Government or other employment or leaving the business of the above contractor/firm, I undertake to inform immediately the Chief Electrical Inspector, Himachal Pradesh. In case of default, I shall be responsible for consequences and of Government action.

Dated______200 .(Signature of applicant)

Name______

Address______

I, the above named deponent do hereby affirm that the contents of my above affidavit are true to the best of knowledge, no part of it is false and nothing has been concealed there from.

Attested by:-Deponent.

Annexure -V

AFFIDAVIT for immovable Property.

I, …………………………aged………………….Son of Sh. ………………………...... do hereby solemnly affirm and state on oath as under:-

  1. That I am owner and in possession of land and house situated in ……………………………………………………………… the value of my above mentioned property is more than …………………………………..
  1. That my above mentioned property is free from all encumbrances.
  1. That if my name is enlisted as contractor with the department in that event my above mentioned property shall remains with the department as security.
  1. That if any loss caused to me in any Government contractorship work in that event the department has full right to recover the said amount from my property.

Deponent.

Verification:-

I, the above named deponent do hereby verify that the content of this affidavit are true to the best of my knowledge and belief. Verified on ………………..

Deponent.

CHARACTER CERTIFICATE (Specimen)

No………………………..Valid From:………………….

It is certified that Sh. …………………………………………………………………………….S/o Sh. ……………………………………….………………resident of Village………………………………Post Office…………………….Teh.…………………Distt.…………………(H.P.) bears good moral character as per report of

Pradhan, Gram Panchayat::………………………………………………

SHO, Police Station: ……………………………………………….

Place:………………………………….

Date: …………………………………

Executive Magistrate

EXPERIENCE CERTIFICATE

(To enroll Class C Electrical Contractor)

This experience certificate is being issued (Name of Department…………………...………..……. ………………………….. or Name of Contractor with Full Address and License No. …………………...) on dated ………….. in favour of Sh./Smt.. …………………..………….. S/o Sh. ……………………...……..……………… Village ……………. P.O. ……………. Teh. …………....Distt………..…… Pin Code……………State…………. that Sh./Smt.……………………………………………. was engaged by me to execute the following works w.e.f. …………………………………… to ………………………….

Sr. No. / Name of Work / Remarks
Write if work executed work order/Tender No. of Semi Government/Government Department against each work.
(a)In case of Private Consumer installation. Write intimate No. and Full Address:-
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Signature of Applicant Signature of Contractor

(Name and Full Address) ( with seal and date)

Note:- Class ‘C’ Electrical License shall be issued to the applicant who himself/herselfis a licensed wireman and having passed I.T.I. in Electrician/Wireman Trade and have one year experience after getting wireman permit or to such persons who himself is a licensed wireman and have passed Matriculation examination and have two years experience after obtaining the wireman permit.