Annexure-XL
(See Rule 129-A of O.M.V Rules, 1993)
APPLICATION FOR THE GRANT/RENEWAL OF AUTHORIZATION
TO CONDUCT POLLUTION TEST OF MOTOR VEHICLES.
1
Full Name (in capital letters) address
2
Father’s Name (in case of an
individual)
Experience in the field of automobile
maintenance
The facility available with
garage/petrol pump/premises (enclose
sketch map of the premises)
Whether sufficient parking facilities
are available for parking (enclose
sketch map)
Whether trained mechanics are
available; if so how many with name,
address and certificate showing their
experience in the field
3
4
5
6
7
8
9
10
Full details of instruments and
equipments maintained
Whether instruments can measure the
level of carbon monoxide and hydro
carbons if it is an exhausted as
analyzer
Proof for having purchased the
instrument and the actual place of their
installation
Whether the mechanics have been
trained by the
dealer/supplier/manufactures (enclose
the certificate to this effect).
11
Whether the applicant mechanics
working under him know
calibration of the applicant.
12
How many canisters of standard
gas in stock for the calibration of
the instruments equipment.
Names of the persons who are
authorized to sign the test report
along with the specimen signature
Any other additional information
relevant to the applicant to show
the department his expertise
knowledge in the vehicle
maintenance
13
14
I here by declare that the information given above is true to the best of
my knowledge. I understand that in any of the information given above is
found to be in correct, at any point of time the licence granted to me for the
emission testing centre is liable to be cancelled. I have gone through all the
relevant Rules of the O.M.V Rules, 1993 and I have understood the same.
Place:
Dist:
Signature of the applicant

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