(1) The nomination referred to in the first proviso to sub-section (1) of Section 22 shall be made in Form X.
(2) The Controller shall maintain a register of nominations filed with him under the first proviso to sub-section (1) of Section 22 of the Act in form XI.
Form I [See Rule 3(1)] Form of application for licence to manufacture, commence or carry on business as a manufacturer of dangerous machines under Dangerous Machines (Regulation) Act, 1983 (35 of 1983)
1. Name of application
2. Whether sole proprietorship/partnership/public limited/private limited company/trust (Attested copy of the deed attached)
3. Full address
4. Dangerous machine for which licence is required
5. Specifications and other details :-
(a) Trade name
(b) Brief description
(c) Overall dimensions
(d) Capacity of prime-mover (in H.P.) required to operate machine
(e) Output (quintals/hour)
(f) Number of persons required to operate
(g) Prescribed standards to which machine conforms or will conform (specify standard)
6. I/We hereby apply for commencing/carrying on business as a manufacturer. A licence fee of Rs.___________ has been deposited in Haryana Government Treasury, - vide Challan No. ________________ dated_____________ (enclosed).
7. (i) I/We declare that the machine to be manufactured will conform to the standards as spelt out in the Dangerous Machines (Regulation) Act, 1983 and rules made thereunder by the Central Government (for applicant proposing to commence business as a manufacturer).
(ii) I/We declare that the dangerous machines being manufactured by us comply with the standards prescribed under Section 13 of the Dangerous Machines (Regulation) Act, 1983 and the rules made thereunder by the Central Government (for applicant proposing to carry on business).
(Strike out 7(i) or (ii) whichever is not applicable).
8. I/We will abide by all the clauses of the Dangerous Machines (Regulation) Act, 1983 and instructions issued by the authorities under the Act from time to time. I/We will keep the record and supply the requisite information to the Controller/Inspectors or persons authorised by them, as and when required.
9. I/We declare that Shri______________, son of ____________, Partner/Managing Director/Shareholder of the firm will correspond with the authorities under the Act on behalf of all the partners concerned with the above firm.
Signature of the applicant.
(Full name in capital letters) Date :
Place :
(Seal of the firm) (For Official Use) Form II [See rule 3(3)] Form of application for licence to commence or carry on business a dealer in dangerous machines under the Dangerous Machines (Regulation) Act, 1983 (35 of 1983):-
1. Name of application
2. Whether sole proprietorship/partnership/public limited/private limited company/trust (Attested copy of the deed attached)
3. Full address
4. Dangerous machine(s) for which licence is required (Give trade name with brief description of each)
5. Do machines conform to prescribed standards ?
(Indicate which standard)
6. Name of manufacturer Whether licenced under the Dangerous Machines (Regulation) Act, 1983 If yes, no. and date of licence, name of licensing authority Note. - Information under (5) or (6) subject to verification will be considered adequate for grant of a licence.
7. I/We hereby apply, for commencing/carrying on business as a dealer in dangerous machines. A licence fee of Rs.________ has been deposited in Haryana Govt. Treasury, - vide challan No._____________, dated______________ (enclosed).
8. I/We declare that I/we will not deal in machines which do not conform to the standards prescribed under the Dangerous Machines (Regulation) Act, 1983 and the rules made thereunder by the Central Government.
9. I/We will abide by all clauses of the Dangerous Machines (Regulation) Act, 1983 and instructions issued by the authorities under the Act from time to time. I/We will keep the record and supply the requisite information to the Controller/Inspector or persons authorised by them as and when required.
10. I/We declare that Shri______________, son of ____________, Partner/Managing Director/Shareholder of the firm will correspond with the authorities under the Act on behalf of all the partners concerned with the above firm.
Signature of the applicant.
(Full name in capital letters) Date :
Place :
(Seal of the firm) (For Official Use) 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 the Dangerous Machines (Regulation) Act, 1983 (35 of 1983) :-
1. Name of applicant
2. Full address
3. Details of licence sought to be renewed -
(i) Licence No. and date
(ii) Validity period.
4. A licence renewal fee of Rs. __________ has been deposited in Haryana Government Treasury, - vide Challan No. __________, dated ________ (enclosed).
5. Is there any change in the partnership deed of firm ? If an give details.
6. I/We declare that I/we have not been convicted/punished under the above Act during the validity period.
Signature of the applicant.
(Full name in capital letters) Date :
Place :
(Seal of the firm) (For Official Use) Form IV [See rule 6] Form of declaration to be made by manufacturer/dealer to enable the registration of dangerous machines under the Dangerous Machines (Regulation) Act, 1983 (35 of 1983).
Sr. No.________________ I have transferred by sale/lease/hire/supply (delete which ever is not applicable) to Shri/Messrs.___________________ (Name) of_________________ (Address) Nos. __________(give figures) of____________ (Name of machine) the undermentioned particulars on______________ (Date) Certified that this machine conforms/these machines conform (delete whichever is not applicable) to the standards laid down by or under the Act and the rules and orders made thereunder :-
1. Make and ..
model
2. Sr. No. of the machine ..
3. Year of manufacture ..
4. H.P./K.W. ..
5. Capacity ..
Signature of the purchaser Signature of manufacturer/dealer Date :
(Name in capital letters) (Seal of the firm) Form V [See rule 7(1)] Form of register to be maintained by the manufacturer under the Dangerous Machines (Regulation) Act, 1983 (35 of 1983) :- Sr.
No.
Month and year of manufacture Brief details of the machine models and size of primemover (if provided with machine) Total number of such machines manufactured Signature of the manufacturer/dealer 1 2 3 4 5 Form VI [See rule 7(2)] Register of monthly stocks to be maintained by the manufacturers/dealers under the Dangerous Machines (Regulation) Act, 1983 (35 of 1983) :- Sr.
No .
Brief descriptio n of the machine, make model Mont h Particular s of the opening stocks Particular s of stocks received during the month Particulars of the machines sold, transferre d or Particular s of the closing stocks Signature of the manufacturer / dealer capacity otherwise disposed of during the month 1 2 3 4 5 6 7 8 Form VI [See rule 8(1)] Form of application by users for registration of a dangerous machine under the Dangerous Machines (Regulation) Act, 1983 (35 of 1983) I/We________________ (Name) of_______________ (Address) own/have acquired control (as hiree/lessee or otherwise) of the machine the particulars of which are given below and beg to apply for the registration of the same :-
(a) Name and number of the machine
(b) Make/Model
(c) Date/Year of purchase/hire/lease or other transferrer
(d) Name and address of the supplier/transfer.
The Certificate to the effect that the machine conforms to prescribed standard is attached.
Certified that I/We have been using the machine since prior to the coming into force of the Act and the machine conforms/has been so modified as to conform to the prescribed standards. A registration fee of Rupees__________ per machine has been deposited, - vide cash/challan No.___________________ date__________ and the receipt is enclosed.
(Signature of the applicant) Name in capital letters Date :
Place :
Form VIII [See rule 8(2)] Form of Certificate to be granted by the Controller, to the user under the Dangerous Machines (Regulation) Act, 1983 (35 of 1983) Registration No. ______________
1. Name of the user
2. Father's/Husband's name of the user
3. Address Particulars of the machine :
(1) Name of the dangerous machine
(2) Make and model
(3) Year of manufacturer with supplier's transferrer's name and address
(4) Sr. No. of the machine, if any The person above named is hereby allowed to use the dangerous machine detailed above.
Signature Seal of the Registering Authority) Date :
Place :
Form IX [See rule 8(3)] Form of register to be maintained by the Controller under Section 19(3) of the Dangerous Machines (Regulation) Act, 1983 (35 of 1983) :- Sr.
No .
Name of the dangerou s machine Manufacture d by (give full address) Supplie d by (give full address ) Make/Mod el capacity and Sr.
No. of the machine, if any Whethe r a new machin e or old modifie d machin e Owned/Use d by (name and full address) Date of grant of registratio n with its No.
1 2 3 4 5 6 7 8 Form X [See rule 9(1)] Form of nomination to be made under the first proviso to sub-section (1) of Section 22 of the Dangerous Machines (Regulation) Act, 1983 (35 of 1983) - I_______________ (Name) , S/o______________ (Name) of ________________ (Address) do not have any family, and consequently I hereby nominate Shri/Smt. _________________ S/o/D/o/W/o__________________ (Name) of _______________ (Address) to receive full payment of the compensation which would be payable under Act in the event of my death during the operation of a dangerous machine.
Signature____________________ Full name ___________________ Place :
Date :
Witness__________________(Name) ___________________(Address) ___________________(Date) Attested by Sarpanch of the concerned village Panchayat or Municipal Commissioner.
Form XI [See rule 9(2)] Form of register of nominations to be maintained by the Controller under the Dangerous Machines (Regulation) Act, 1983 (35 of 1983) Sr.
No.
Received from (Give name and full address of the operator making the nomination and also the date of making nomination) Name of the operator's employer Name and full address of the nominee Remarks 1 2 3 4 5 the machine
(b) Make/Model
(c) Date/Year of purchase/hire/lease or other transferrer
(d) Name and address of the supplier/transfer.
The Certificate to the effect that the machine conforms to prescribed standard is attached.
Certified that I/We have been using the machine since prior to the coming into force of the Act and the machine conforms/has been so modified as to conform to the prescribed standards. A registration fee of Rupees__________ per machine has been deposited, - vide cash/challan No.___________________ date__________ and the receipt is enclosed.
(Signature of the applicant) Name in capital letters Date :
Place :
Form VIII [See rule 8(2)] Form of Certificate to be granted by the Controller, to the user under the Dangerous Machines (Regulation) Act, 1983 (35 of 1983) Registration No. ______________
1. Name of the user
2. Father's/Husband's name of the user
3. Address Particulars of the machine :
(1) Name of the dangerous machine
(2) Make and model
(3) Year of manufacturer with supplier's transferrer's name and address
(4) Sr. No. of the machine, if any The person above named is hereby allowed to use the dangerous machine detailed above.
Signature Seal of the Registering Authority) Date :
Place :
Form IX [See rule 8(3)] Form of register to be maintained by the Controller under Section 19(3) of the Dangerous Machines (Regulation) Act, 1983 (35 of 1983) :- Sr.
No .
Name of the dangerou s machine Manufacture d by (give full address) Supplie d by (give full address ) Make/Mod el capacity and Sr.
No. of the machine, if any Whethe r a new machin e or old modifie d machin e Owned/Use d by (name and full address) Date of grant of registratio n with its No.
1 2 3 4 5 6 7 8 Form X [See rule 9(1)] Form of nomination to be made under the first proviso to sub-section (1) of Section 22 of the Dangerous Machines (Regulation) Act, 1983 (35 of 1983) - I_______________ (Name) , S/o______________ (Name) of ________________ (Address) do not have any family, and consequently I hereby nominate Shri/Smt. _________________ S/o/D/o/W/o____________ (Name) of _______________ (Address) to receive full payment of the compensation which would be payable under Act in the event of my death during the operation of a dangerous machine.
Signature____________________ Full name ___________________ Place :
Date :
Witness___________________ (Name) ____________________ (Address) ____________________ (Date) Attested by Sarpanch of the concerned village Panchayat or Municipal Commissioner.
Form XI [See rule 9(2)] Form of register of nominations to be maintained by the Controller under the Dangerous Machines (Regulation) Act, 1983 (35 of 1983) Sr.
No.
Received from (Give name and full address of the operator making the nomination and also the date of making nomination) Name of the operator's employer Name and full address of the nominee Remarks 1 2 3 4 5