Form I

{See rule-3(2)}

Application for registration of establishment/Amendment to certificate

ofregistration/ Updation of registration particulars of establishments

already registered under any other State Labour Laws

A. Establishment Details.

1. Retrieve details of Establishment through LIN:

2. Name of Establishment:

3. Location and Address of the Establishment:

3a.PAN:

4. Other details of Establishment:

a. Total Number of employees engaged directly in the establishment:

b. Total Number of the contract employees engaged:

c. Total Number of Inter-State Migrant workers employed:

5(a) for factories:

Details of the Full postal address and Name and Maximum number of

manufacturing situation of the factory address of the workers to be

process along with plan occupier and employed on any day

Approval details manager

1 2 3 4

5(b) For Motor Transport Undertakings:

Name of the Maximum number Total No. of Registration Date of

MTU of persons to be Vehicles numbers of Commencement

employed on any the vehicles

Day (RTO)

1 2 3 4 5

5(c) For Beedi Cigar Establishments:

Name of Establishment Maximum number of persons to be Commencement

employed on any Day

Inside the factory Out-side the factory

1 2 3

5(d) For Plantation Labour:

Name of Establishment Maximum number of persons to be Commencement

employed on any

Day

1 2 3

5(e) For News Paper Establishments:

Name of Establishment Maximum number of persons to be Commencement

employed on any Day

1 2 3

5(f) For Cine worker & Theatre worker Establishments:

Name of Establishment Maximum number of persons to be Commencement

employed on any Day

1 2 3

5 (g) For Building and other construction work:

Type of Probable Expected Details of Maximum Probable

Construction period of period for approval number of cost of

persons to be construction

work commencemen completion of the

employed on

t of local

any

Of work Work Authority

Day

1 2 3 4 5 6

6. Ownership Type/ Sector:

7. Activity as per Nationa lIndustrial Classification:

8. Details of Selected NIC Code:

9. Identification of the establishmente-sign/digital sign of

employer/representative:

B. Details of Employer:-

1. Name & Address of Employer/Occupier/Owner/Agent/Chief

Executive/port authority etc.:

2. Designation :

3. Father’s/Husband’s Name of the Employer:

4. Email Address, Telephone & Mobile No.:

C. Manager/Agent Details

1. Full name & Address of Manager/Agent or person responsible for

supervision and control of the Establishment

2. Address of Manager/Agent:

3. Email Address,Telephone & Mobile No.:

D. Contractor Details:

Name Email Name of Maximum No.of Date of

Work

and address & Contract labour Commencement

Address Mobile of engaged /Probable date of

Contract Contractor Completion of

or work

1 2 3 4 5

E. Other Details:-

Signature/E-sign/digital sign of

employer

Dated:

Place;