ELECTRICAL LICENSING BOARD,

ODISHA
*******

Name of the Person/Firm :

Amount deposited :
Challan No. & Date :
Sl.No.
Signature of Issuing Authority

FORM – “B”
(REGULATION-27)

APPLICATION FOR ELECTRICAL CONTRACTOR’S LICENCE

1. Name (In block letters) in which :

The License is required

2. Business Address :

3. Full Name & Address of Proprietor/ :

Managing Partner/Director
Authorized representative.

4. Category of work for which :

Permanent License is required

Contd….P/2.
 -:2:-

5. Details of work project for which :

License/Extension is required.

6. Period for which temporary :

License/Extension is required

7. If a contractor’s license (permanent :

or temporary) was previously issued in the
Same name details to be furnished.

8. Names of Supervisors & Electrical : 1.

Workman to be engaged to be mentioned
2.
(The Ref.No.of S.C.C. and Workman’s
Permits to be furnished), 3.

4.

5.

9. Particulars of Testing Equipments :

available.

10. Details of :

(i) Treasury Challan enclosed :

(ii) Income Tax Clearance Certificate :

and VAT Clearance Certificate.

11. Compliance of other requirement specified :

by the Government.

We hereby declare that the particulars stated above are correct to the best of
my/our knowledge and belief.

Place : SIGNATURE

Date :

DESIGNATION