Form 24

(See rules 62 and 63)

Application for grant, renewal of license or work specific license for a contractor

(i) Whether the application if for: (a) grant of license (b) renewal of licences (c) work-

specific license

(ii) Name and address of the contractor

(iii) Father’s Name

(iv) Particulars of establishment where contract labour is to be employed:

(a) Name and address of the establishment:

(b) Type of business, trade, industry, manufacture or occupation carried on the

establishment.

(c) Number & date of Certificate of registration of the establishment under the code.

(d) Name and address of the Principal Employer:

(v) Particulars of the Contract Labour:

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

establishment:

(b) Duration of proposed contract work (give particular of proposed date of commencing

& ending)

(c) Name and address of the authorised person of Contractor at establishment

(d) Maximum number of contract labour proposed to be employed in the establishment on

any date

(e) No. of interstate migrant workers to be employed: Fill details in Form No. 5 as

mentioned in Rule 6

(vi) Amount and particulars of License fee deposited;

(vii) Amount and particulars of security deposit, if any, of requested to be adjusted:

Signature of the Applicant – Contractor