Sr. No.

Address of factory where products using Ozone Depleting Substances are produced (including Tehsil, District, State)

Name of products being manufactured *1

Date of incorporation registration

Date of commencement of commercial production

1.

2.

3.

4.

4. Name of business house/group to which the enterprise belongs:

Schedule ………………………….……………….XI

5. Please give name of Managing or chief Executive.

Form

………………………………………………..11

6. Please enclose a copy of the latest Annual Report, Audited Balance Sheet and Profit & Loss Account of the enterprise.

Page………………………………………………….2

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

Verification

I declare that the enterprise/firm mentioned in Sl. No. 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 Products to include one of the following:-

(i) Aerosols (excluding metered dose inhalers for medicinal purposes); (ii) Foam Products; (iii) Fire Extinguishers or fire extinguishing systems; (iv) Mobile Air Conditioners; (v) Other Regrigeration & Air conditioning products (excluding compressors); (vi) Products where ozone depleting substances are used as solvents; (vii) Metered Dose Inhalers for medicinal purpose.