FORM 6





[SEE RULE 154 (5)]



APPLICATION FOR GRANT OF A LICENCE TO POSSESS EXPLOSIVES FOR OWN USE



I hereby apply for a licence to possess explosives as mentioned below for my own use for removal of tree stumps/leveling of ground digging of new well deepening of existing well. The purpose of ……………………………………………………..A certificate

No …………dated……….. from…………… as required under sub-rule (8) of rule 155 of the Explosives Rules, 1983, is also enclosed.

Replies to be given in this column.

1. Name of the applicant …. ……… ……. ….

2. Age of the applicant ……… ………. ….. …

3. Residential address of the applicant ……. ……… …….. ….

4. Location of the premises shall be used …….. …… ………. ….

Survey No. ……… ……… ……. …

5. Mode of storage

6. Location of the- premises where the explosives shall be stored

7. Quantity of explosives proposed to be stored

(i) Gun Powder

(ii) Nitrate Mixture

(iii) Nitro-compound

(iv) Safety Fuse

(v) Electric Detonators

(vi) Ordinary Detonators

8. Particulars of the licence obtained by the applicant during last two years

(a) Has the applicant been convicted under any law or ordered to execute a bond under Chapter VIII of the Code of Criminal Procedure, 1973, during the last ten years? Yes No

(b) If yes, give details

9.

(a) Particulars of licence held by the applicant under the Explosives Act, 1884, during the last 10 years .. .. .. ..

(b) Was licence cancelled/not renewed? Yes No

(c) If yes, give details .. .. … ..

10. Any other information

I certify that the information given by me above is correct.

Place ……………

Signature of applicant…………..

Date of application…………….

NOTES. -

(1) The applicant should attach site plan and construction of the premises-where the explosives shall be stored.

(2) Delete whichever is not applicable.