Form-A Application for Registration of Establishments Employing Migrant Workman 1. Name and location of the establishment __________________________________ 2. Postal address of the establishment ________________________________________ 3. Full name and address of the principal employer (furnish with Father's/Husband's name in the case of individuals) ______________________________________________ 4. Name and addresses of the directors/particular partners (in case of companies and firms) __________________________________________________________________ 5. Full name and address of the Manager or persons responsible for the supervision and control of the establishment. ________________________________________________ 6. Nature of work carried on in the establishment _______________________________ 7. Particulars of contractors and migrant workman (a)Name and address of contractors __________________________________________ (b) Nature of work for which, migrant workman are to be recruited or are employed (c) Maximum number of migrant workman to be employed on any day through each contractor _______________________________________________________________ (d) Estimated date and commencement of work under each contractor ______________ (e) Estimated date of termination of employment of migrant workman under each contractor _______________________________________________________________ 8. Particulars of fees deposited (Name of the Bank, Amount, Number and date) No. of Treasury receipt and date. ____________________________ I hereby declare that the particulars given above are true to the best of my knowledge and belief. NOTE: The application should be accompanied by the treasury receipt Principal Employer For the requisite fee. And Stamp. Date of receipt of application Office of the Registering Officer
