FORMS UNDER APSE ACT Government of Andhra Pradesh LABOUR DEPARTMENT Application for Registration FORM - I Of Establishment under Section (1) & Rule (3) Vide Rule 3 A.P.Shops & Establishment Rule 1990 ------------------------------------------------------------------------------------------------ 1. Classification of Establishment 1. Proprietory Firm 2. Partnership Firm 3. Private Limited Company 4. Public Ltd., Company. ------------------------------------------------------------------------------------------------ 2. Category of Establishment 1. Shop 2. mercial Establishment 3. Hotel, Restaurants Catering House Lodging and Caf 4. Public Ltd., Company. ------------------------------------------------------------------------------------------------ 3. Name of Establishment _________________________________ _________________________________ ------------------------------------------------------------------------------------------------ 4. Address : Door No.______________________________ Locality _______________________________ Village/Town __________________________ District ________________________________ Pin Code ------------------------------------------------------------------------------------------------ 5. Location of Office, Godown, Ware- Door No. Locality house or Work Place attached to 1.______________ _______________ the Shop/Establishment but 2.______________ _______________ situated outside the premises of it. 3.______________ _______________ ------------------------------------------------------------------------------------------------ 6.Employer/Managing Partner/ Name : ___________________________ Managing Director as the Father's Name _____________________ case may be Designation _______________________ ------------------------------------------------------------------------------------------------ 7. Residential address of the Door No. ______________________________ employer Locality _______________________________ Village / Town _________________________ ------------------------------------------------------------------------------------------------ 8. Manager/Agent if any with Name _________________________________ residential address Father's Name __________________________ Designation ____________________________ Door No. ______________________________ Locality _______________________________ Village / Town. _________________________ ------------------------------------------------------------------------------------------------ 9. Nature of Business : ------------------------------------------------------------------------------------------------ 10. Date of Commencement Date Month Year of business : ------------------------------------------------------------------------------------------------ 11.Name of family member of employees family engaged in Shop/Establishment ------------------------------------------------------------------------------------------------ Relationship Adults Young Persons ------------------------------------------------------------------------------------------------ Male : Female : ------------------------------------------------------------------------------------------------ Total ------------------------------------------------------------------------------------------------ 12. Total No.of Employees Adults Young persons Male Female Total ------------------------------------------------------------------------------------------------ 13. Name of Employees : ------------------------------------------------------------------------------------------------ In a Managerial Capacity | As Sweeper caretaker| As persons employed | Others | & Travelling Staff | loading & unloading | | | of goods at godowns | ------------------------------------------------------------------------------------------------ 1. 2. 3. 4. ------------------------------------------------------------------------------------------------ | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | ------------------------------------------------------------------------------------------------ 14. Details of remittances of the fees : ------------------------------------------------------------------------------------------------ Name of the Treasury | Challan No. | Date | Amount of fee paid ------------------------------------------------------------------------------------------------ 1. 2. 3. 4. ------------------------------------------------------------------------------------------------ | | | | | | | | | | | | | | | | | | | | | | | | ------------------------------------------------------------------------------------------------ I declare that the above information is true to the best of my knowledge & belief ------------------------------------------------------------------------------------------------ Signature of the Employer Note : This statement shall be submitted to the Inspector of the concerned area accompained by challan in support of payment of fees as Prescribed Schedule 1.
