Assesment Order:

Signature of the applicant ..........................

with seal

Verification

I declare that the enterprise/firm mentioned in Serial. 1 above has not applied for registration under sub-rule (1) of rule 6 of the Ozone Depleting Substances (Regulation and Control) Rules, 2000 with any other registering authority.

I ................... S/o ................. do hereby solemnly verify that to the best of my knowledge and belief the information given above and the annexure and statements any accompanying it are correct and complete.

I further declare that I am submitting and verifying the information given above in my capacity as .................. and that I am competent to do so.

Place................................

Date..................................

Signature *2................................ [The above form including the verification portion must be signed in case of an individual, by the individual himself or a person duly authorized by him: in case of Hindu undivided family, by the Karta, in case of a partnership firm, by the managing partner, in case of a company, by a person duly authorized in that behalf by the Board of Directors and in any other case, by a person incharge of or responsible for the conduct of the business.]

with seal

Notes:-

*1 Please see Schedule I for list of all ozone depleting substances.

*2 The above form including the verification portion must be signed in case of an individual, by the individual himself or a person duly authorized by him: in case of Hindu undivided family, by the Karta, in case of a partnership firm, by the managing partner, in case of a company, by a person duly authorized in that behalf by the Board of Directors and in any other case, by a person incharge of or responsible for the conduct of the business.

FORM 11 - Page 1

Form For Registration Of Enterprises Using Ozone Depleting Substances In Activities Specified In Column 2 Of Schedule Iv

(Sub-rule (1) of rule 8)