Labour Department

Form I

Application for Registration of Establishments Employing Migrant Workman

Fields marked with * are mandatory.

Establishment Details

1. Type of Establishment *:

2. Name of the Establishment *:

3. Postal address of the Establishment *:

a. District *

b. Tehsil *

c. City/Village *

d. Survey No. *

e. Postal Code *

Employer Details

1. Full name of the Principal Employer *

2. Aadhar No. :

3. Address of Principal Employer *:

4. Mobile No. * :

5. Email id:

6. Name of employer's Father/ Husband :

(In case of Individuals)

Other Details

1. Full name of the Directors/ Particular Partners :

(In case of companies and Firms)

2. Address of Directors/ Particular Partners :

3. Full name of the Manager/ Person responsible for supervision/control of Establishment*:

4. Address of Manager / Supervisor *:

4. Nature of work carried on in establishment *:

Particulars of Contractors and Migrant Workers

1. Name of Contractors *:

2. Address of Contractors *:

3. Nature of work for which, migrant workman are to be recruited or are employed *:

4. Maximum number of migrant workman to be employed on any day through each contractor *:

5. Estimated date of commencement of work under each contractor *:

6. Estimated date of termination of employment of migrant workman under each contractor *:

DECLARATION

This is to certify that the information furnished is true and correct to the best of my knowledge and belief. I also affirm that in case, I have provided wrong information, I am liable for action by Competent Authority.