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QuestionAnswer
Form NameAe 3 Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesexplosive licence application form ae 3, form ae3, form ae 3 pdf, drive googl

Form Preview Example

Form AE-3

(See rule 113 of the Explosives Rules, 2008)

Application for approval or grant or amendment or transfer of licence for

possession and sale of explosives; for possession and use of explosives; or for possession

of fireworks or safety fuse in a store house

I,…………………………………..on behalf of…………………………………….apply

for approval or grant or amendment(1) of licence for the following purpose.

1.Purpopse: (Write the purpose corresponding to particular article as per Schedule IV, Part 1) …….…………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………..

2.Name: I require licence in the following name and postal address:

(a) Name in which licence is required

………………………….

to be granted (see notes below)

 

(b) Status(1)

 

(c)Age(2)

 

(d)Postal address:

………………………………………………………………………………………………

………………………………………………………………………………………….City

………….. District……………………………State……………………Pin code…………………...

Police Station………………… Railway Station / Steamer Ghat………………….

Phone……………………………E-mail…………………..Fax…………………………

3.The proposed premises are situated at the following address:

………………………………………………………………………………………………

…………………………………………………… Survey number

…………………….City …………..

District……………………………State……………………Pin code…………………...

Police Station………………… Railway Station / Steamer Ghat………………….

Phone……………………………E-mail…………………..Fax…………………………

4. Qualifications and experience of applicant

………………………….

And the technical personnel employed by him.

………………………….

(Give individual details and attach separate

………………………….

sheet if required)

………………………….

5. (a) Explosives proposed to be possessed and sold:*

Name and Class

Division if

Quantity

Description

any

 

 

 

 

at any one time

In one month

i.

ii.

iii

.

iv.

v.

vi.

(b)Are the premises attached to a factory licensed to manufacture explosives?

If so, please give the licence number

……………………………………..

6.(a) Explosives proposed to be possessed and used* –

Name and Class

Division if

 

 

Quantity

 

Description

any

To

be

To be used

To be

 

 

possessed

per day

used

 

 

at

any

 

in one

 

 

one time

 

month

i.

ii.

iii

.

iv.

v.

vi.

(b) Details of site where explosives will be used ……………………………………..

(c ) Whether the site is coming under the Mines Act,1952:…………………..

(If yes,documentary evidence to be submitted ; if not, particulars of proposed activity, documentary evidence and shot firer employed to be furnished)

(d)List of documents attached with reference to clause (c) above

(i)… (ii)…. (iii)…

(e) Distance of site where the explosives will be used

 

 

from the storage premises mentioned in item 6

……………………………………..

(f) Mode of transport of explosives

……………………………………..

(g) Licence particulars. of road van, if used

 

 

……………………………………..

 

 

7. Has the applicant been convicted under any offence

………………………….

or ordered to execute bond under Chapter VIII of

………………………….

Code of Criminal Procedure, 1973, during the last

………………………….

10 years. If yes, please give details.

 

 

8.(a) particulars of other licenses under

…………………………..

Explosives Act, 1884, if any held by

…………………………..

the applicant during the last 10 years

……Yes…………No.…..

(b) was any licence cancelled or not renewed?

 

…………………………..

(c ) If yes, give details

…………………………..

I hereby certify that the above particulars given by me are correct.

Date…………………………..

Signature of applicant…………………………..

 

(Authorised person in case of a Company)

 

Full Name …………………………..

 

Address …………………………..

*strikeout inapplicable portion Notes:

Please see the rule for the purpose and documents to be enclosed

(1)In case where application is made by a person other than an individual, the names and addresses of the occupier as per rule 2 and directors or partners or members, as the case may be, and specimen signatures of authorised person to be attached.

(2)Passport size photographs of the occupier to be attached.

(3)Any change in the above information should be immediately communicated to the licensing authority and authority renewing the licence.

(4)Age to be given in case the applicant is an individual.

Statutory Warning: Mishandling and misuse of explosives shall constitute serious criminal offence under the law.

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