Place *

 

Starting date of Licence *

 

 

Name of contractor *

 

Address of contractor *

 

 

Date of birth

 

Age

 

 

Guardian Name

 

Type of business/Trade/Industry

 

 

Name of Establishment *

 

Address of Establishment *

 

 

Number of certificate of registration of the establishment under the Act *

[eg.IR03011ADR0003]

 

Date of certificate of registration of the establishment under the Act *

 

 

Name of Principal Employer

 

Address of Principal Employer

 

 

Nature of work in which migrant workmen are employed or are to be employed in the establishment

 

Duration of the proposed contract work (give particulars of proposed date of commencing and ending)

 

 

Duration of Contract From date

 

Duration of Contract To date

 

 

Name of the agent or manager of the contractor at the work site.

 

Address of the agent or manager of the contractor at the work site.

 

 

Maximum number of migrant workmen proposed to be employed in the establishment on any date. *

 

 

 

 

 

Name of Director/Partners

 

Address of Director/Partners

 

 

Name (s) of person (s) incharge of and responsible to the company/firm for the conduct of the business of the company/firm, as the case may be.

 

Address (s) of person (s) incharge of and responsible to the company/firm for the conduct of the business of the company/firm, as the case may be.

 

 

Whether a Certificate by the Principal Employer in Form VI is enclosed?

 

 

 

 

 

Whether the Contaractor convicted of any offence within 5 years

 

If Yes, Details

 

 

Whether there is any order against the Contractor

 

If Yes, Details

 

 

Whether the contractor worked in any other Establishment

 

If Yes, Details

 

 

Email

 

Phone

 

 

Upload Form VI (Only pdf)*

 

Upload Agreement Copy (Only pdf)

 

 

Upload Employees Details (Excel file only)

 

 

 

 

 

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