Form III — See Rule 17

FORM III
                                                       (See rule 17)

                                (REGISTER FOR CERTIFIED STANDING ORDERS)

                                                         PART- I

                                                  Industrial Establishment

Unique and    Name of the         Nature of the      The areas of         Whether standing         Date of adoption or
continuous    industrial          industrial         operation of the     order is                 date of deemed
number        establishment       establishment      industrial           (a) model standing       authentication or date
                                                     establishment        order, or                of
                                                                          (b) deemed standing      certification /
                                                                          order or                 authentication of
                                                                          (c) certified standing   standing order
                                                                          order

     (1)               (2)                (3)                (4)                   (5)                        (6)

Date of    Date and           Amendment         Date of the dispatch of the copy of      Any other relevant detail
filing     nature of          made on           standing orders as settled on appeal
appeal     decision           appeal, if any

   (7)          (8)                 (9)                            (10)                                (11)

                                                         PART-II

                             Enclose the certified copy of the standing orders electronically.