5.
Name of Ozone Depleting Substance
Purpose* 1 for which Ozone Depleting Substance is purchased
Quantity of Ozone Depleting Substance purchased
Kg.
Kg.
Kg.
Kg.
Kg.
Kg.
6.
Has the purchaser ever been convicted of an offence under Indian law applicable in respect of ozone depleting substances?
__________________
__________________
Yes
No
Signature of the Purchaser of the Ozone Depleting Substances
With seal *2.
VERIFICATION
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 making and verifying this declaration in my capacity as ...................and that I am competent to do so.
Place................................
Date..................................
Signature 3*.......................................
with seal
Note. -
*1. Purposes are: (i) Manufacture of aerosols (excluding metered dose inhalers for medicinal purposes).
(ii) . Manufacture of Foam products.
(iii) . Manufacture of Fire extinguishers & Fire extinguishing systems.
(iv) . Manufacture of Mobile Air Conditioners.
(v) . Manufacture of other Refrigerations & Air Conditioning products (excluding compressors).
(vi) Solvents used.
(vii) . Exempted use.
(viii) . Selling.
(ix) . Servicing of fire extinguishers of fire extinguishing systems (applicable for Group II ODS).
(x) . Manufacture of metered dose inhalers for medicinal purposes.
(xi) . Manufacture of compressors.
(xii) Others - specify (excluding servicing).