Place *
Starting date of Licence *
Name of contractor *
Address of contractor *
Date of birth
Age
Guardian Name
Type of business/Trade/Industry
Name of Establishment *
Address of Establishment *
Number of certificate of registration of the establishment under the Act *
[eg.IR03011ADR0003]
Date of certificate of registration of the establishment under the Act *
Name of Principal Employer
Address of Principal Employer
Nature of work in which migrant workmen are employed or are to be employed in the establishment
Duration of the proposed contract work (give particulars of proposed date of commencing and ending)
Duration of Contract From date
Duration of Contract To date
Name of the agent or manager of the contractor at the work site.
Address of the agent or manager of the contractor at the work site.
Maximum number of migrant workmen proposed to be employed in the establishment on any date. *
Name of Director/Partners
Address of Director/Partners
Name (s) of person (s) incharge of and responsible to the company/firm for the conduct of the business of the company/firm, as the case may be.
Address (s) of person (s) incharge of and responsible to the company/firm for the conduct of the business of the company/firm, as the case may be.
Whether a Certificate by the Principal Employer in Form VI is enclosed?
Whether the Contaractor convicted of any offence within 5 years
If Yes, Details
Whether there is any order against the Contractor
If Yes, Details
Whether the contractor worked in any other Establishment
If Yes, Details
Email
Phone
Upload Form VI (Only pdf)*
Upload Agreement Copy (Only pdf)
Upload Employees Details (Excel file only)
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