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Place * |
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Starting date of Licence * |
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Name of contractor * |
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Address of contractor * |
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Date of birth |
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Age |
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Guardian Name |
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Type of business/Trade/Industry |
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Name of Establishment * |
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Address of Establishment * |
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Number of certificate of registration of the establishment under the Act * |
[eg.IR03011ADR0003] |
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Date of certificate of registration of the establishment under the Act * |
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Name of Principal Employer |
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Address of Principal Employer |
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Nature of work in which migrant workmen are employed or are to be employed in the establishment |
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Duration of the proposed contract work (give particulars of proposed date of commencing and ending) |
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Duration of Contract From date |
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Duration of Contract To date |
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Name of the agent or manager of the contractor at the work site. |
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Address of the agent or manager of the contractor at the work site. |
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Maximum number of migrant workmen proposed to be employed in the establishment on any date. * |
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Name of Director/Partners |
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Address of Director/Partners |
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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. |
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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. |
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Whether a Certificate by the Principal Employer in Form VI is enclosed? |
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Whether the Contaractor convicted of any offence within 5 years |
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If Yes, Details |
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Whether there is any order against the Contractor |
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If Yes, Details |
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Whether the contractor worked in any other Establishment |
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If Yes, Details |
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Email |
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Phone |
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Upload Form VI (Only pdf)* |
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Upload Agreement Copy (Only pdf) |
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Upload Employees Details (Excel file only) |
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Enter Captcha* |
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