Form A - Application for Electrical Contractor's License

Form A

Application for Electrical Contractor's License

1. Name of firm in which an Electrical Contractor's License is applied* ABC Electrical Contractors Ltd.
2.a. Business address (as specified in GST Registration) #101, Building Name, Colony Name,
City Name, State Name, Pin Code-797001
2.b. Business Phone No. +91 9876543210
2.c. Business Email contact@abcelectrical.com
3. Whether the license is sought for:* Company
4. In case of company/partnership firm, whether authorisation letter for Authorised Signatory is enclosed in Form A3* Yes
5. Full name of the Proprietor/Authorised Signatory* John Doe
6. Applicant's Father's Name* James Doe
7. Home Address same as business address? No
7.a. Home Address #202, Residential Complex,
City Name, State Name, Pin Code-797001
7.b. Home phone number +91 9876543211
7.c. Home EmailID john.doe@email.com
8. Date of Birth (DD/MM/YYYY)* 01/01/1990
9. Indigenous Inhabitant of Nagaland/ ST Certificate issued after 2.02.2016* Yes
10. Class of License applied for* Class I (Exceeding 33 kV)
11. Previous License No. (if any) ECL123456
12. No. of Supervisors employed* 5
13. No. of Workmen employed* 20
14.a. Initial Fee payment* ₹5000
14.b. Challan No.* CHL789012
14.c. Challan Date* 14/03/2024
15. List of instruments maintained by the applicant furnished in Form A1* Yes

Declaration & Specimen Signature

I JOHN DOE hereby declare that the particulars stated above are correct to the best of my knowledge. I fully understand the Terms and Conditions under which an Electrical Contractor's License is granted, a breach of which will render the License liable to cancellation.

Further, I hereby also declare the I have in my possession the latest copy of the Electricity Act 2003; Central Electricity Authority (Measures relating to Safety and Electric Supply) Regulations, 2023; Terms and Conditions of Supply of Electrical Energy and Nagaland Electrical Licensing Regulations.

Specimen Signature

Signature of Applicant

Date:

Passport Photo

Documents Submitted Checklist (Unchecked means not submitted)

  • PAN Card
  • Aadhar Card
  • Proof of Home Address
  • Form A1 - List of Instruments
  • Form A2 - List of Supervisors
  • Form A2 - List of Workmen
  • Form A3 - Authorization Letter
  • GST Registration Certificate
  • ST/Indigenous Certificate
  • Previous License Copy
  • Fee Payment Challan
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