SCHEDULE V {(See Rule 12 (2) ] FORM –LR-2 (Application Form of renewal of licence as Repairer of Weights, Measures, weighing Instruments and Measuring Instruments under the Standards of weights and Measures (Enforcement)Act, 1985). 1. Name and complete address of the repairing concern /person seeking the licence. 2. 3. Repairer’s licence Number and complete address of the workshop. Name(s) and address(es) of proprietor(s) and or /partners, and Managing Director(s) in the case of Limited Company. 4. 5. Number and date of current Municipal Trade Licence. (a) The types of articles which are repaired as per licence granted (b) Do you propose any change 6. 7. 8. area in which you are operating Have you sufficient stock of loan /test weights, etc., Please give details with particulars of stamping
To be Certified by the Applicants. Certified that I / We have read the Standards of Weights & Measures (Enforcement Act 1985 and the Karnataka Standards of Weights and Measures (Enforcement) Rules, 1988 and agree to abide by the same and also the administrative orders & Instructions issued or to be issued there under. I/We have deposited the scheduled licence fees of Rs ………..
(Rupees………………….. ……….) to the Sub Treasury /Bank on ……………… and the original challen is enclosed. All the Information furnished above is true to the best of my / our knowledge.
Place : Date:
Signature and Designation.