Application Form For License For Employment of Contract Labour

Service Specific Information

Specify whether applying for Fresh/Backlog Application *

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Existing License Number *

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Existing License Issue Date *

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Unique Business Identification Number Details

Specify UBIN *

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Specify PAN Number *

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Applicant's Information

Applicant's Full Name *

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Designation *

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Office Address *

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Mobile Number *

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E-Mail *

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Telephone Number

Name of the Enterprise *

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Application Processing Location

Select Office Location *

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Particulars of Establishment where contract labour is to be employed

Name of the Establishment *

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Postal Address/Location of the Establishment *

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Full Name of the principal employment *

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Full Address of the principal employment *

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Certificate Registration No. : *

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Date of Certificate Registration *

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Type of business, trade, industry, manufacture or occupation which is carried on in the establishment *

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Particulars of Contractor

Full Name of Contractor *

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Full Address of Contractor *

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Furnish father's name in case of individuals

Date of Birth in case of individuals

Whether the contractor was convicted of any offence within the preceding five years? *

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Yes

No

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If so give details *

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Whether there was any order against the contractor revoking or suspending license or forfeiting security deposits in respect of an earlier contract? *

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Yes

No

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If so, date of such order *

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Whether the contractor has worked in any other establishment within the past five years? *

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Yes

No

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If so, give details of the principal employer, establishment and nature of work. *

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Particulars of Contract Labour

Nature of work in which contract labour is employed in the establishment *

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Proposed Date of commencing the contract work *

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Proposed Date of ending the contract work *

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Full Name of agent or manager pr contract at the work site *

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Full Address of agent or manager pr contract at the work site *

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Maximum number of contract labour proposed to be employed in the establishment on any date (Payment will be decided based on numbers) *

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License Fee Payable *

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Security Deposit Payable *

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Declaration

I hereby declare that the details given above are correct to the best of my knowledge and belief.

I Agree *