FORM NO. 4
Prescribed under Rule 4 (4)
Licence to work a Factory
1. Licence Number
2. Registration Number
3. Full name of Factory
4. Full Address/location of factory
5. Full postal address for communications
6. Maximum horse power installed regular / standby
7. Maximum number of workers to be employed
8. Full name, father's name, age & residential
Licence is hereby granted to the factory at 3 above for the premises stated at 4 above for use as a factory within the limits stated in 6, and 7 above subject to the provisions of the Factories Act, 1948 and the Rules made thereunder.
This licence shall be valid until it has been duly cancelled.
Date Inspector of Factories