* Mandatory Field
Note: Please complete the form within 20 Minutes.

Before proceeding, please ensure that you fulfill the eligibility criteria for the post and have read the instructions given under 'HOW TO APPLY' .
Please also ensure and that the information to be fed is readily available with you.
Basic Details :
SELECT YOUR MAIN MACHINE TYPE FOR TESTING: *
SELECT YOUR Sub MACHINE TYPE FOR TESTING: *
1. Applicant Details :
Name of the applicant :*
Full Address: *

Pin Code : *


Contact No. : *


FAX No. : *


E-Mail address : *


2. Manufacturer Details :
Name of the Manufacturer :*
Full Address: *

Pin Code : *


Contact No. : *


FAX No. : *


E-Mail address : *


3. If the applicant is not the manufacturer, capacity in which the testing has been requested to
(as authorized importer/distributor/ designer/respective manufacturer) *


4. Details of the machine to be submitted for test*

Type *

Make *


Select Model Of Machine
(Tick the relevant)*

Brand Name’s *


5. Type of work the machine or component has been designed for and special features of the machine. If any.
(Tick the relevant)*
6. Whether the machine submitted for testing is a prototype or commercial model.
(Tick the relevant)*
7. Nature of test (Commercial or confidential)*
8. If confidential specify details of test submitted for*

9. Total number of machines (as in 4 above ) produced/imported since inception to till date.*


10. Whether all the parts are produced indigenously? If no, attach list of imported parts.*
11. Period suitable for random selection of the machine (in case of machines already in commercial production & sale)*

12. i) Type of accessories and attachments that are basically sold along with the machine.
Use Comma for Sepration


12. ii) Accessories and attachments to be sent with the machine. detail of fields


14. Indicate the no. of additional copies of the test report required.*


15. Whether testing fee is remitted.*
16. Do you propose to depute representative to witness the test*

17. Additional information to be furnished:*

17. i)Details of letter or indent/Registration/COB License No. and capacity sanctioned by the Ministry of Industry.*


17. ii) Whether machine has been tested earlier in India/Foreign country (If so attach a copy of the test report) ?*

17. iii) In case of Power Thresher, sugarcane crasher, chaff cutter details of safety harvester may be indicated in line with of relevant Indian Standard.*


17. iv) Any other details.*


Payment Details For Test Fee
DD No *
DD Date * - -
Amount(Rs)* /-
   
Bank* Branch *
Payment Details For Service Tax
DD No *
DD Date * - -
Amount(Rs)* /-
   
Bank* Branch *
Photograph and Signature :
 If the Upload Photo / Signature is not loaded in appropriate place, your application is liable to get rejected

Allowed Photo Size � 20KB to 50 KB
Allowed Signature Size � 10 KB to 20KB
Photograph of the Candidate : *      
Signature of the Candidate : *