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Industry Details :

 
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Site Address *
District
Regional Office
Type of Industry
   

Industry's Director Details :

 
Name of Director *
Address *
Telephone No. (L/L) *
Mobile No. *
Email Id
   

Contact Details during Emergency :

 
Contact Person during Emergency *
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Telephone No. (L/L) *
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Fee Details :

 
Applying For
Enter Your Industry's Capital Amount
Fee Amount *
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Transaction No. *
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Product Details :

 
Product Name
Production Capacity
Manufacturing Process (Attach Flow Chart)
   

Raw Material Details :

 
Name of Chemical
Storage Capacity
1.
2.
3.
4.
5.
6.
Storage Method
   

Other Details :

 
Possibility and consequences of major hazard from the industry
MSDS of Chemical
Accident History
Status of submission of on-site emergency plan
Status of submission of safety audit report
Other Information, If any
   
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Since : Sep-2011


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