SCHEDULE VA

( See rule 12(1) )

FORM LR1

Application for Licence as Dealer Manufacturer of Weights, Measures, Weighing Instruments and Measuring Instruments under the Standards of Weights and Measures ( Enforcement ) Act, 1985.

To

The Controller of Legal Metrology, West Bengal,

45, Ganesh Chandra Avenue, 3^rd floor,

Kolkata - 700 013.

To be filled by the Comments of the Inspecting

applicants. Officer

___________________________________________________________________________________________

(1) (2) (3)

___________________________________________________________________________________________

1. Name of the repairing concern/person

seeking the licence :

2. Complete address of the workshop and

Office :

3. Date of establishment :

4. Name(s) and address(es) of proprietor(s)

and/ or partners and Managing Director(s)

in the case of Limited Company :

5. Number and date of current Municipal

Trade Licence :

6. The types of articles you propose to

repair :

7. Area in which you wish to operate :

8. Exten of previous experience in the

line :

9. The number of skilled staff ecmployed

in the workshopo :

10. Is electric energy available ? :

11. Have you sufficient stock of loan/test

weights, etc. ? Please give details :

12. Have you previously applied for Repairer

Licence ? If so, when and with what

Results ? :

[ To be certified by the applicant(s) ]

Certified that I/We have read the Standards of Weights and Measures (Enforcement) Act, 1985 and the West Bengal Standards of Weights and Measures (Enforcement) Rules, 1990 and agree to abide by the same and also the administrative orders and instructions issued or to be issued thereunder.

I/We agree to deposit the schedule licence fees and security deposit with Government as soon as required to do so by the Licensing Authority.

All the informationfurnished above is true to the best of my/out knowldege.

Place : Signature and designation

Date :

( To be filled in by Departmental Officer of the State Government )

Date of receipt of application …………………………

Serial Number of application ………………………….

Date of Inspection ………………………..

Recommendation of Inspecting Officer

Place : Signature and Designation of Inspecting Officer.

Date :

Final Orders of Licensing Authority

Licence granted/refused ……………………………

Licence No. ………………………..

Valid till …………………………… Date ………………………..

Place : Signature of Controller of Legal Metrology,

West Bengal.

Date :