:::Labour Department:::

छत्तीसगढ़ शासन श्रम विभाग

e-श्रमिक सेवा

होम

श्रमायुक्त

भवन एवं अन्य संन्निर्माण

असंगठित कर्मकार मंडल

श्रम कल्याण मंडल

राज्य कर्मचारी बीमा सेवाए

औद्योगिक न्यायलय

इज ऑफ़ डूइंग बिज़नेस

Application For License Under Contract Labour ACT 1970

FORM-IV
[See C.G. Rules 21(1)]
Application For License

Particular's of Contractor's Establishment

Name*

Land Mark*

Address*

State*

Dist*

Rural/Urban*

Block Name*

Pin Code*

* *

E.P.F. Registration No*

Date of Commencement of Work/Proposed Date *

E-Mail ID*

If Registered Under Companies ACT*

YES

Particulars of contractor in Person

Contractor Name*

Designation*

Father's Name *

Date of Birth *

Age *

* *

Postal Address *

State*

Dist*

Rural/Urban*

Block Name*

Pin Code*

Adhar Number *

PAN Card Number *

* *

Mobile Number *

* *

Email-ID *

Particulars of Agent/Manager of Contractor

Full Name*

Designation*

Father's Name*

Postal Adress*

State*

Dist*

Rural/Urban*

Block Name*

Pin Code*

* *

Adhar Number *

PAN Card Number*

* *

E-Mail ID*

Mobile Number*

* *

Information on Establishment of Principal Employer

Category of Establishment

Is Establishment

Government

Private

Whether Contractor was convicted of any offence withing preceding five years?

Select One*

YES

Whether any order Passedagainst the Contractor Revoking/Suspending License/Forfeiting Security Deposit ?

Select One*

YES

Whether the Contractor Worked in any Establishment within Five Year?

Select One*

YES

Whether Certificate issued By Principal Employer In FORM -V enclosed

Upload Form V

Download FOrm FORM -V Formate

Payment of License Fee

E-Chalan (Chalan Head =>0230 श्रम और रोजगार 106 संविदा श्रमिक (विनिमय उन्मूलन) एक्ट के अंतर्गत प्राप्तियां)

Help for e-challan

E-Chalan(Treasury Ref) Number

License Fee

* * + =
Total License Fee

Security Deposit

E-Chalan(Chalan Head =>K Deposite Advance (6) Deposite Not Bearing Intrest
8443 Civil Deposite 116 Deposite under Various Contacts
Labour /Regulation and Abolition/Act 1970 (Security Deposite)

Help for e-challan

E-Chalan(Treasury Ref) Number

Security Deposite

* *

User Detail

User Name

Password

Mobile Number

* *

Telephone Number

I hereby declare that the particulars given and document uploaded here in above are true to the best of my knowledge and belief