Performa of application for Annual Clearance Certification

* Timeline 15 days
* All fields are mandatory

Proposed/Compounding/Building name: *

Address: *

Mobile: *

Telephone No.

Fax No.

Email: *

Pincode: *

Name of Authorized Coordinator/ Contact Person: *

Email: *

Mobile: *

Select District:*

Type of Building: *

Lift with Fire Switch: *
Yes No

Emergency/Optional Source of Electric Supply: *

Exit: *
Yes No

Provision of Smoke / Fire check Doors: *
Yes No

Attachment Type: (pdf | png | jpg | jpeg | docx)*

Attachment:

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All above said information is correct with the best of my knowledge and belief. *