FORM III [See rule 4] Form of application for renewal of licence to manufacture, commence or carry on business as a manufacturer or dealer of a dangerous machine under Dangerous Machine (Regulation) Act, 1983 :- 1. Name of applicant: 2. Full Address: 3. Details of licence sought to be renewed- (i) Licence Number and date (ii) Validity period. 4. A licence renewal fee of Rs.__________________ (Rupees _______________________) as been deposited in Punjab Government Treasury _______________________ vide challan No.______________ dated __________________________ (copy enclosed). 5. Is there any change in the partnership deed of firm, if any, give details. 6. I/we declare that I/we have not been convicted/punished under the above Act during the validity period. Date: Signature of applicant. Place: Name in Capital Letters). Seal of the firm
