Thanks to visit codestin.com
Credit goes to www.scribd.com

Scribd
Upload
167 views2 pages

Form AS 1 Old Form 1 PDF

The document is an application form for obtaining, amending, transferring, or renewing a license to store compressed gas or dispense auto LPG as vehicle fuel in India. The form requests information such as the name and address of the applicant, the location of the storage premises, details of the compressed gas to be stored such as quantity and chemical name, and any other licenses already held for the premises. The applicant must declare that the information provided is true and agree to abide by the license terms, and submit documents such as facility plans, the license fee, and safety certification if required.

Uploaded by

sri kanth
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
167 views2 pages

Form AS 1 Old Form 1 PDF

The document is an application form for obtaining, amending, transferring, or renewing a license to store compressed gas or dispense auto LPG as vehicle fuel in India. The form requests information such as the name and address of the applicant, the location of the storage premises, details of the compressed gas to be stored such as quantity and chemical name, and any other licenses already held for the premises. The applicant must declare that the information provided is true and agree to abide by the license terms, and submit documents such as facility plans, the license fee, and safety certification if required.

Uploaded by

sri kanth
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

134 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC.

3(i)]

FORM -AS-I
(See rules 50, 54 and 55)
Application for grant, amendment, transfer or renewal of a licence in Form LS-1A/LS-1B to store compressed
gas/Auto LPG in vessel or vessels and dispense Auto LPG in Auto LPG Dispensing Station as automotive fuel to
motor vehicles.
DOCUMENTS LISTED IN THE NOTE MUST BE ENCLOSED WITH THIS APPLICATION

The replies to be given in this column.


1. Name in which licence is required:*
2. Status of applicant(individual/company/partnership/Society):
3. Licensee’s complete postal address with pin code
Phone No. with STD code : Fax No.
Mobile No.
Email:
4. Location of the premises where compressed gas in vessel(s) is to be stored:
(a) Plot/Survey/Khasra/Gat No.(s):
(b) Town/Village:
(c) Tahsil/Taluka/Mandal:
(d) Police Station:
(e) District and State:
(f) PIN Code:
5. Chemical name and nature of compressed gas proposed to be stored:**
(please state whether flammable, corrosive or toxic or other type)
6. Chemical name of compressed gas already stored in the premises:***
7. (i) Quantity of the compressed gas/Auto LPG proposed to be stored.**(strike out whichever is not applicable):
(ii) Quantity of the compressed gas/Auto LPG already stored in the premises*** (strike out whichever is not
applicable):
(iii) Quantity of Petroleum already stored, if any:
8. Particulars of the licence held for the premises under SMPV(U) Rules and Petroleum Rules, if any and full
name of the licensee:
I hereby declare that the statements made above have been checked up by me and are true and I
undertake to abide by the terms and conditions of the licence which will be granted to me.
Date of Application
Signature & designation of the applicant.
*Where the application is made on behalf of a Company, the name and address of the Company and the
name of the Manager or Agent should be given and the application should be signed by him. Every change in the
name of the Manager or Agent shall be forthwith intimated to and his specimen signature filed with the licensing
authority.
** Applicable for grant of licence.
*** Applicable for amendment, transfer and renewal case
NOTE:
DOCUMENTS REQUIRED TO BE SUBMITTED WITH APPLICATION
Four copies of specifications and plans approved under rule 46 (NOT REQUIRED FOR
¹Hkkx IIµ[k.M 3(i)º Hkkjr dk jkti=k % vlk/kj.k 135
RENEWAL OF A LICENCE WITHOUT AMENDMENT)
Licence together with approved plans and specifications attached thereto (NOT REQURIED FOR
THE FIRST GRANT OF LICENCE).
Requisite amount of fee for the grant, renewal, transfer or amendment of licence.
A certificate of safety if required under rule 33 together with test and inspection certificate and as-
built design drawing of new vessel duly endorsed by Inspector (in case of installation of new vessel or
repair/modification of any vessel)

You might also like