Form XIII

(See Rule-43)

APPLICATION FOR LICENSE

On Line Application for License/ Renewal of License/Amendment of License (including

Common/single license)

Labour Resource and Migrant Workers Welfare Department Government of Bihar

ESTABLISHMENT PROFILE:

Labour Identification Number /Registration No.- Date

.........................................

Acknowledgement Number:

…………………………………………………………………….……… Date of Application:

……..………………….

I. Particulars of Establishment for which licence required:

1. Name of Establishment:

2. Address of establishment

(a) Head Office address along with email Id :

(b) Corporate office address along with email Id:

3. Telephone Number :

4. Activity as per National Industrial Classification : (Select all applicable activities given)

5. Details of selected NIC Code:

6. Nature of work carried on in main establishment :

7. Esign/digital sign of applicant :

II. Details of Employer:

1. Full Name of Employer: …………………………………………………relationship with

establishment.

2. Full Address of Employer:

3. Email Id of employer:

4. Mobile No. of employer:

III. Particulars of the Contract Labour to be employed / is employed (If licence is required

work wise)

Locations Name Activity as per Date of Date of Name of Name

of of national commencement completion Establishments Address,

worksites works industrial in which email id

classification contract labour of the

is/proposed to Site

be employed Incharge

1 2 3 4 5 6 7

5. Maximum number of workmen proposed to be employed on the Establishment on any date: 24

6. Amount of Licence Fee: INR ( Transaction Id : )

7. Amount of Security Deposit: INR ( Transaction Id : )

IV. DETAILS OF ESTABLISHMENTS FOR WHICH COMMON LICENCE REQUIRED,

(IF APPLYING FOR)

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(i)Nature of work

carried out in the

establishment (ii)

Activity as per

National Ind‘l

classification

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Maximum Maximum

number of number of

employees employees

employed/ employed/

proposed to proposed

be to be

employed employed

1 2 3 4 5 6 7

V. DETAILS OF ESTABLISHMENTS FOR WHICH SINGLE LICENCE IS REQUIRED

(IF APPLYING FOR)

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Maximum

number of

labour will be/is

employed

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Permanent Maximum Registration

establishment number of number, if

or probable employees obtained, then

date of employed/ details thereof

completion proposed to be

employed

1 2 3 4 5 6 7

Signature of Contractor

(eSign/DSC)

Note: This is an online application summary applied on Shram Suvidha Portal.

APPLICATION FOR RENEWAL OF LICENCE

1. Licence No. Date :

2. LIN & PAN

3. Name and address of the establishment:

4. Date of expiry of previous licence :

5. Whether the licence of the employer/contractor was suspended or revoked:

6. Details of Fees paid : (Enclose e-payment receipt): Amount …. date of payment :

E-sign /digital sign of the employer/contractor date:

APPLICATION FOR AMENDMENT OF LICENCE :

1. Licence No Date:

2. LIN & PAN

3. Name and address of the establishment:

4.Details for which amendment is sought :

(a). Maximum number of worker presently employed : (If there is increase in the maximum number

of workers to be employed, then additional fees/security deposit as per law needs to be deposited:

(b). Details of fees paid through e payment date on which made :

(c). Other details requiring amendment in the licence issued (Necessary documents may be uploaded

in support of change required)

E-sign /digital sign of the employer/contractor date of application