Form 49

(See rules 82, 84, 96, 97, 98, 99, 149)

Application for grant / renewal / amendment / transfer of license as a factory / industrial

premises for beedi or cigar /engagement of contractor

1. Application for license –

(a) as a factory

(b) for engagement of contractor

(c) Industrial premises for beedi and cigar work

2. Full name and postal address of the establishment

3. Registration of establishment under the Code :

4. Details of person who will be occupier / principal employer

(a) Name

(b) Permanent address

(c) Local address

(d) Emil

(e) Mobile number

5. Full name and address of the owner of the Premises of building (including the

percents thereof)

6. Core activity to be under taken along with details of hazardous substances as per

section 2(za) of the Code.

7. NIC code

8. (a) Total number Employees and Workers to be employed in the period of license

(b) Total Number employees and Workers were employed during last calendar

year

9. Particulars aof Contract Labour :

(a) Nature of work in which contract labour is employed or to be employed>

(b) Maximum number of contract labour to be Employed on any day:

(c) Number of Inter-State Migrants (Fill details in form no. 5 as mentioned in rule 6)

(d) Estimated date of commencement of each Contract work under each contractor:

(e) Estimated date of termination of employment of contract labour under each contractor

:

10. Power:

Connected or proposed to be connected (in KW)

11. Furnish Reference :

(a) approval of plans

(b) Stability certificate

(c) Disposal of trade waste / effluents / hazardous waste / e-waste / biomedical waste

(Which is applicable)

12. Details of fee

Sr. Particular Amount Date

No

a Factory

b Engagement of Contractor

c Industrial premises

DSC of Employer / Occupier