FORM IV [See rule 6] Form of declaration to be made by manufacture, or dealer to enable the registration of dangerous machine under the Dangerous Machine (Regulation) Act, 1983 :- Serial No._______________ I have transferred by sale/lease/hire (delete which ever is not applicable) to Shri/Messrs ______________________________________________________________________________________ (Name) Of__________________________________Number ________________________________________of ___________________________________________ of the under mentioned particulars of the machine) On______________________________ (Date) It is certified that this machine conforms/these machines conform (delete which ever is not applicable) to the standards laid down by or under the said Act and the rules and orders made there under :- 1. Make and model 2. Serial Number of the machine 3. Year of manufacture 4. Horse power/Killowatt. 5. Capacity Signature of the manufacturer/dealer Signature of the purchaser Date : (Name in Capital Letters) (Seal of the firm).
