Application Ref. No. of the current License *

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Applicant's Full Name

Applicant's Full Name *

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Application Processing Location *

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E-Mail *

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Mobile Number *

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Name of the Establishment *

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Postal Address/Location of the Establishment *

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License Number *

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

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Current license Expiry Date *

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Full Name of the principal employment *

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Proposed Date of ending the contract work *

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

I Agree *