1 Form 1

( 3 ) [See Regulation 3]

BUREAU OF INDIAN STANDARDS

Product Certification Scheme

" ' "

APPLICATION FOR LICENCE TO USE THE STANDARD MARK

)*+ /
Full name of individual or firm
Address

Tel

/
Office

5
Fax
City

District

2 State

Country

Pin

-
E-mail

Address

Tel

59
FACTORY

5
Fax
City

District 2 State

Country

Top Management
Name

Management

Pin

=
Designation

1.
2.
3.
4.

/ > )*+ .
CONTACT PERSON & Tel No.

Technical Management

Name

1.
2.
3.
4.

-
E-mail

Designation


CORRESPONDENCE
ADDRESS

/
Office
59
Factory

F
SCALE

Large

Small

G
SECTOR

/
Public

Private

-------------- =
" >
This application is being made to use the BIS Standard Mark on -------------------------------------

PRODUCT

INDIAN STANDARD

IS:
Part:

B//E
GRADE/TYPE/CLASS

Sec:

/ F G
PRESENT INSTALLED
CAPACITY
( / )
(Production per annum)

=
Units of Production

Quantity

I
(J.)
Value (Rs.)

K F/
M5, O ,
DETAILS OF PREVIOUS CANCELLATION/CONVICTON
IF ANY UNDER BIS ACT

/ =
SEAL OF FIRM
FG ------------------------------------------Signature

Name ---------------------------------------------- --------------------------------------------Designation

= K -----------------------------------Date of applicaton

1. / =
F ' K
2. / = F '

K FG R
K

FG R

3. K ' > M > (R) " '

Important: 1. Application should be signed by CEO of the firm, or in his absence by authorized representative.
2. Application from Foreign Manufacturers should be countersigned by authorized Indian representative.
3. Please inform whether you are holding BIS licence(s) for any product(s).