:::Labour Department:::

Application For License Under Inter State Migrent Workmen ACT 1979

FORM-V
[See C.G. Rules 7(1)]
Application For License For Recreuitment
(Inter State Migrent Workmen ACT 1979 )

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*

Bloack Name*

Pin Code*

* *

Adhar Number *

Pan Card Number*

* *

E-Mail ID*

Mobile Number*

* *

Information on Establishment of Principal Employer

Category of Establishment

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)

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E-Chalan Number

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)

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E-Chalan Number

Security Deposite

* *

User Detail

User Name

Password

Mobile Number

* *

Telephone Num,ber

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