Form A - Statement under section 5

Form of submitting a statement, the fees and other particulars under sub section (1) of Section 5.- Within 90 days from the date mentioned in column 2 in respect of Establishments mentioned in column 1, the occupier of the establishment shall send to the Chief Inspector a statement in Form A together with 1[prescribed fee paid in cash not exceeding one hundred rupees] 2[or a crossed postal order] in token of payment of such fees as are prescribed in Schedule I

FormA