“FORM-F” (Clause 23)

H P STATE LICENSING BOARD

APPLICATION FORM FOR GRANT OF ELECTRICAL CONTRACTOR LICENCE CLASS “C”
1. Name in which Electrical Contractor License is applied for:

2.
Business Address-
Affix Recent Passport Size
Photograph Attested by a
Gazetted Officer
Pin Code-

E-mail-

Phone No-
3. 3. Particulars of the fee deposited:
1) Name of Treasury _______________________________________________________________________________
2) Amount in Rs._______________________________________Date:_______________________________________
4. Whether attested three specimen signature by the Gazetted
officer of the below mentioned is supplied:
(i) Individual Contractor holding wireman permit
5 Whether a contractor licence has been previously granted in the
same name? If yes, give details thereof.

6. Whether a contractor Licence has been issued under this name by any
other

State Licensing Board? If so, please give name of issuing Authority-

Date of issue-

Date of expiry of Licence-

Details of works permitted to be undertaken-

7 Whether three recent passport size photographs out of which one
photograph to be got attested from the front to be attested by a
Gazetted officer of each individual contractor, owner of the Firm
and Supervisor is to be supplied
8. Particulars of the wireman permit of the holder.

Sr. No. Name of Applicant Qualification Wireman Whether declaration in

permit No. the form appended have
and date of been attached
expiry

9. Library:
Whether the following books are in his/her possession (yes/No)_____________________________________
SR. No. Name of Books
I.S.: 732-1963 Code of practice for electrical wiring installation (System Voltage not
1 exceeding 650 Volts)

2. I.S. 5216-1969 Guide for safety procedures in Electricity Works.

3. Central Electricity Authority (Measures Relating to Safety and Electric Supply) Regulation,
2010
4.

10. Details of punishment and penalty imposed on the company/firm.

1) By State Licensing Board, Himachal Pradesh.

2) By Government & Other agencies.
3) Any Court of Law.

Signatures
 Declaration
 I have read and understood the conditions and documents required to be attached with application for

grant of Electrical Contractor Licence Class “C‘ and relevant documents are attached in chronological

order.

 I  I hereby declare that I have in my possession a copy of the Electricity Act 2003, Central Electricity

Authority (Measures Relating to Safety and Electric Supply) Regulation, 2010 v as well as relevant

codes of Practice and Standards of Indian Standards Institution relating to Electrical Installations. I fully

understand the terms and conditions under which an electrical contractor licence is granted, a breach of which

will render the licence liable to cancellation.

 I hereby also agree to maintain such registers and records as may be prescribed by the Board in the

forms specified for the purpose.

 I do solemnly affirm and declare that the facts submitted in the application are true and correct to the

best of my knowledge and nothing has been concealed by me.

 I are fully aware that this self declaration has the same validity as duly sworn statement of fact in a

court of law and any false information provided by me through this application shall be liable for punishment

under the relevant sections of the India Penal Code 1860.

Place:

Dated:- Signature
 Form of Declaration

(To be submitted by applicant with Copy of Wireman Permit)

1. I ............................................. S/o Sh..............................................hereby undertake that presently I am not

working under any Contractor/firm/Govt/ Semi-Govt. Department/Org.

2. I am at present employed under Ms./Shri/M/s____________________I have already given notice(vide letter

dated_________) /will give notice to her/him/them of my intention to leave the service under her/him/them

3. I shall intimate the Licensing Board as well as_______________________ under whom I am working at present.

4. I also hereby affirm that I shall abide by the provisions of the Electricity Act and Regulations as well as of

the State Licensing Board Himachal Pradesh Rules and with all circulars/instructions which are issued by the

State Licensing Board and the Electrical Inspectorate in all respects.

Place:

Date:

Name and Signature of Applicant

Self Attested
 Annexure-B
Specimen of EXPERIENCE CERTIFICATE (For Grant
Of C-Class Electrical Contractor License)

It is certified that Sh………………………………………. S/o.Sh. …………………………………………_bearing Electrical Wireman Permit

No.WM-……………………….. _valid upto……………………………Village…………………………… Post Office:……………………………………
Tehsil ……………………………._District………………………………. _H.P. has worked under my Firm/Contractor/organization full
address ………………………………………………………………………………………………__ Electrical Contractor License No…………………
Class-………………….. Valid upto…………………_.He has worked against following works at the supply voltages as shown for
the period w.e.f ______________ to__________________. He is capable to carry out/supervise the electrical works
individually with free from danger.
Sr. Name of Work Supply voltages
No
.
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Signature of Applicant Signature of Issuing Authority

(Name and Full Address)

 6
ANNEXURE-C
Verification of instruments for the year:_____________________________________

Name of the Contractor:____________________________________________________

Class of Contractor applied for:________________________________________________

Sr. Name of Instruments Make Sr. No. of In working Original Cash Book Copy of test
N Instruments order/Defective No. and date certificates
o

1 I.S.I. Approved Insulation

Tester/ Megger of 0-100
Mega Ohms, 500 Volts.
2 One line Tester.

1. Name of Books:
I.S.: 732-1963Code of practicefor
electrical wiring
installation (SystemVoltage
not exceeding 650 Volts)

3 I.S. 5216-1969 Guide for safety

procedures in Electricity Works.

4 Central Electricity Authority

(Measures Relating to Safety
and Electric Supply)
Regulation, 2010

Signature of contractor Checked by ...........................................................Counter Signed by:-

(Not below the rank Secretary Licensing Board,
of Assistant Electrical Inspector) Block No. 29, SDA Complex,
H.P. Shimla-171009
 STAFF REGISTER TO BE MAINTAINED BY THE ELECTRICAL CONTRACTORS

Name of Contractor Applied for..................................................................……………License No...................……………………………

Name of Wireman and full Wireman Permit Period of Date of Signature of Signature of
Sr. address No. validity appointment Wireman the Contractor
No

Name of Apprentices and Apprentices Period of Date of Signature of Signature of

Sr. full address Certificate of validity appointment Apprentices the Contractor
No Competency No.
 CONDITIONS
Read conditions carefully before submitting the application form:

1. QUALIFICATIONS:
a. Applicant should have passed Matriculation examination from a recognized Board/ University
(attach copy).
b. The Applicant who have passed I.T.I. in the Trade of Electrician and having a valid wireman
permit renewed up to date (attach copy)
OR
c. The Applicant who have passed the matriculation examination and having a valid wireman
permit renewed up to date (attach copy).
d. The applicant who tends to obtain the C-class wiring contractor license should not have any
employment under any Contractor/firm/Government or Semi-Govt. Department/any other
Organization.
e. Applicant should be citizen of India (proof of Nationality be attached).

2. COST OF FORM: Cost of Form amounting to Rs. 100/- be paid through Treasury challan in the Head
of Account given below and the original receipted challan be sent with the application form:
Head of Account:

0043- Taxes and Duties on Electricity

800- Other Receipts

01- Misc. Receipts.

DDO Code: 950, and 077 for Capital Treasury, Shimla.

3. EXPERIENCE:
Class ‘C’ Electrical Wiring Contractor shall be granted to the applicant who
himself/herself is a licenced wireman and having passed the I.T.I. in Electrician/Wireman
Trade and having one year experience under “A” or “B” Class Electrical Wiring
Contractor after obtaining the wireman permit

OR

To such person who himself/herself is a licence wireman and have passed Matriculation examination
and have two years experience under “A” or “B” Class Electrical Wiring Contractor after obtaining
the wireman permit

The experience certificate as per the Annexure -A‘ should be attached with the application form.

4. INSTRUMENTS:
The Applicant should have following ISI approved Instruments in his possession and the original cash
memo/bills thereof should be attached with the application form:

a) ISI Approved Insulation Tester/ Megger - 500 Volts.

b) Line Tester - 500 Volts.
 5. LIBERARY:
The Applicant should have following books in his possession and the original cash memo/bills thereof
should be attached with the application form:
a) I.S.: 732-1963 Code of practice for electrical wiring installation (System Voltage not exceeding
650 Volts.
b) I.S. 5216-1969 Guide for safety procedures in Electricity Works.
c) Central Electricity Authority (Measures Relating to Safety and Electric Supply) Regulation, 2010
6. CHARACTER CERTIFICATE:
Character certificate as per Annexure-F should be attached with the application form.

7. FEE:
The fee for the grant of C-class license amounting to Rs. 2500/- shall be charged
subsequent to the case file approved by H.P. State Licensing Board. The applicant in this
regard shall be intimated separately.
8. PHOTO & ENVELOPS:
Three passport size recent identical photographs and Two self addressed envelops of size
25x12 cms. duly stamped for Rs. 27/- be enclosed with the application form.
9. Certification:
All the photocopies attached with application form in support to grant the license should have
self certified or original shown in this office.
10. Proof of Authenticity: The applicant who intend to obtain C-class license must have to
produce/attach copy of GST number in proof of their authenticity either at the time of
grant of license or renewal /up gradation of his license.
11. Last Date of Receipt of Application Form:

Application Form for the grant of C-class license complete in all respects should reach in
the office of Chief Electrical Inspector, Block No. 29, SDA Complex, Kasumpt, Shimla (HP)
171009 fifteen days before the proposed date of meeting of the state licensing board .
The incomplete application form shall not be entertained and automatically stand cancelled.
No correspondence shall be done in this regard.

12. VERIFICATION:
The applicant who fulfill the above conditions shall have to attend the office of Chairman
Licensing Board-cum-Chief Electrical Inspector, Block No. 29, SDA Complex, Kasumpti-171009
(H.P.) in person along with requisite instruments, Books their original billsand original Wiremen
Permit for verification. The date for which will be intimated later on.

Secretary Licensing Board

Uploaded on 03-10-2018
 CHECK LIST
Class-C, Electrical Contractor License (For New case)

Sr. Description Remarks Page

No. No.
1. Whether application filled up properly and signed Yes/No
2. Whether requisite fee Rs. 100/- with original challan submitted.
3. Whether self declaration submitted by wireman.
4. Whether self attested copy of wireman permit submitted & valid for next five
years.
5. Whether Staff register submitted and signed by all employees and employer
and got verified dt………………………………….
6
*
Whether experience certificate of wireman showing upto 240Volts works as
issued by contractor by writing License No. & Validity.
For I.T.I Holder : One year: - from the date of issue of permit.
For those passed wireman Examination: Two Years…………….do………………..
7. Whether Instruments & Books along with original cash memo submitted and
got verified on ………………..
8. Whether applicant has submitted the required character certificate issued by
Executive Magistrate.
9. Whether applicant has submitted the required Bonafide Himachali certificate
issued by Executive Magistrate.
10. Whether three specimen signature attested by Gazetted officer submitted.
11. Whether filled test report form submitted
12. Whether GST Registration copy submitted
13. Whether self addressed enevelope two nos. duly stamped for Rs. 27/- & Rs.37/-
enclosed
14. Whether declaration of contractor submitted.
*
Note:- Experience certificate:- The experience of company/registered firm/PSU are along with
appointment letter, joining & employer undertaking and in case contractor the photo copy of month wise
attendance register signed by contractor & self attested by the applicant.

Verified By Verified By

(Assistant Electrical Inspector) (Technical Assistant License)