UBIN AND BOILER NUMBER

UBIN *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Boiler Registration Number *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Application Processing Location

Form 5 issued from (Please select) *

---pendingNotExist---

Head Office

Zonal Office

District Office

Chief Inspector of Boilers

---pendingEnd--- ---pendingExist--- ---pendingEnd---

Head Office Located at *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Zonal Office Located at *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

District Office Located at *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Chief Inspector of Boilers *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Particulars of Owner

Name *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Address Line 1 *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Address Line 2

Address Line 3

Country *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

State *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

District

Postal / Zip Code *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Mobile Number *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

E-Mail

Particulars of Installation

Address Line 1 *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Address Line 2

Address Line 3

Country *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

State *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

District

Postal / Zip Code *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Previous Details Of Boiler for Steam Test

Makers Number *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Name of Manufacturer *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Year of Manufacture *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Type of Boiler *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Registration No. *

---pendingNotExist--- ---pendingEnd--- ---pendingExist--- ---pendingEnd---

Boiler

Small Industrial Boiler

Boiler Rating (SqM)

Fabrication at Site required

Yes

No

Tentative Date for Inspection (for Steam Test)

Fees Paid