FORM NO.

3
(Prescribed under rule 4)
APPLICATION FOR REGISSTRATION AND GRANT OF RENEWAL OF LICENCE FOR THE YEAR 2007-2008 AND
NOTICE OF OCCFUPATIONSPECIFIED IN SECTIONS 6 AND 7

1 Full name of the Factory with Factory Licence : Time Technoplast Ltd. 232,HPSIDC, Baddi, Distt.-
number if already registered Solan (H.P.)
L & E (FAC) 9-171/05
2. (i) Full postal address and situation of the factory Same as above

(ii) Full address on which communications relating Same as above

to the factory should be sent

3. Nature of manufacturing process /processes : MFG. OF DISPOSABLE SYRINGES,

AUTO DISPOSABLE BLOOD SAMPLER,
MEDICATED MASKS AND OTHER
MEDICAL PRODUCTS

(i) carried on in the factory during the last twelve

months (in case of the factory already in existence) : DO

(ii) to be carried on in the factory during the next twelve

months (in case of all registered factories)

4. Name and value of principal products manufactured : DISPOSABLE SYRIGES, AUTO

during the last twelve months. DISPOSABLE BLOOD SAMPLER,
MEDICATED MASKS.

5.(i) Maximum number of workers proposed to be employed : Below 50 Nos.

on any one day during the year.

(ii) Maximum number of workers employed on any one day : 42 Nos.

during the last twelve months.

(iii) Number of workers to be ordinarily employed in : 40

the factory.

6 (i) Nature and total amount of power (H.P.) installed or : 650 KW

proposed to be installed

(ii) Maximum amount of power (H.P) proposed to be used : 650 KW

7. Full name and residential address of the person who shall : SH. SANJEEV SHARMA ,#232 ,HPSIDC,
be the manager of the factory for the purpose of the Act Baddi, Distt.- Solan (H.P.)
8 Full name and residential address of the occupier : SH.BHARAT VAGERIA,102 TODICOMPLEX,35,

(i) The proprietor of the factory in case of a private SAKI VIHAR ROAD ANDHERI (E) MUMBAI-72
firm/proprietory concern

(ii) Directors in case of a public limited liability :

company /firm

(iii) Where the Managing Agent has been appointed, :

the name of Managing Agents and Directors thereof

(iv) Share-holders in case of a private company where no :

managing agents has been appointed

(v) The Chief Administrative Head in case of a : N. A

Government or local fund factory

9 Full name and address of the owner of the premises or : TIME TECHNOPLAST LTD.232,HPSIDC,
building (including the precincts thereof) BADDI, DISTT. SOLAN
referred to in section 93

10. In the case of a factory constructed or extended after :

the date of the commencement of the rules

(a) Reference number and date of approval of the plan : As per Approved Plan
For the site whether for old or new building and for
Construction or extension of factory by the state
Government/Chief inspector

(b) Reference number and date of approval of the agreement : NOC obtained
if any, made for the disposal of trade waste and effluents
and name of the authority granting such approval.

11. Amount of fee

Rs………………………(Rupees……………………………………………………………………….) paid
In…………………….Treasury………………………………….vide……………………………………
Challan No……………………………….(enclosed in original).

Date:…………………………………… Signature of occupier

Date:…………………………………… Signature of Manager