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    Application For License Form 4

    Uploaded by

    Aijaz Khaja
    This document contains a form for contractors to apply for a license under the Contract Labour Act. [1] It requests information such as the contractor's name and address, date of birth, establishment details, particulars of contract labour including work details and maximum number employed, criminal convictions, previous license issues, and other work experience. [2] The contractor must declare the details are true and the application must include a treasury receipt for security deposit and form from the principal employer. [3] Space is also provided to list the names and addresses of up to 40 workers employed by the contractor.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application For License Form 4

    Uploaded by

    Aijaz Khaja
    88 views2 pages
    This document contains a form for contractors to apply for a license under the Contract Labour Act. [1] It requests information such as the contractor's name and address, date of birth, establishment details, particulars of contract labour including work details and maximum number employed, criminal convictions, previous license issues, and other work experience. [2] The contractor must declare the details are true and the application must include a treasury receipt for security deposit and form from the principal employer. [3] Space is also provided to list the names and addresses of up to 40 workers employed by the contractor.

    Original Title

    Application for License Form 4

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    This document contains a form for contractors to apply for a license under the Contract Labour Act. [1] It requests information such as the contractor's name and address, date of birth, establishment details, particulars of contract labour including work details and maximum number employed, criminal convictions, previous license issues, and other work experience. [2] The contractor must declare the details are true and the application must include a treasury receipt for security deposit and form from the principal employer. [3] Space is also provided to list the names and addresses of up to 40 workers employed by the contractor.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    88 views2 pages

    Application For License Form 4

    Uploaded by

    Aijaz Khaja
    This document contains a form for contractors to apply for a license under the Contract Labour Act. [1] It requests information such as the contractor's name and address, date of birth, establishment details, particulars of contract labour including work details and maximum number employed, criminal convictions, previous license issues, and other work experience. [2] The contractor must declare the details are true and the application must include a treasury receipt for security deposit and form from the principal employer. [3] Space is also provided to list the names and addresses of up to 40 workers employed by the contractor.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    FORM IV

    [See Rule 21(1)]

    1. Name and Address of Contractor -


    including his father’s name in case of individual

    2. Date of Birth ( in case of individual) -

    3. Particulars of establishment -
    (a) Name & Address of establishment
    (b) Type of Business, Trade, Industry, Manufacture or
    Occupation, which is carried out in the establishment
    Under the Act
    (c) Name and address of principal employer

    4. Particulars of Contract Labour: -


    (a) Nature of work in which contract work is employed/
    to be employed
    (b) Name & Address of Agent or Manager or Contractor
    at work site
    (c) Maximum No. of Contract Labour to be employed

    5. Whether the contractor is convicted of any offence -


    within the five proceeding years

    6. Whether there was any order against the contractor -


    revoking or suspending license of forfeiting Security
    Deposit in respect of an earlier contract

    7. Whether the contractor has work in any other -


    establishment within the past five years

    8. Whether the certificate by the Principal Employer in -


    Form V is enclosed.

    9. Amount of License fee paid No. & date of Treasury


    Challan

    10. Amount of Security Deposit in Treasury Receipt No. & -


    Date

    Declaration:- I do hereby declare that the details given above are true to the best of my
    knowledge and belief.

    Signature of the Contractor

    Note:- The application should be accompanied by the Treasury Receipt for the appropriate
    amount and a receipt in Form V from the Principal Employer

    To be filled up by the Licensing Officer

    Date of receipt of application


    with Challan for Security Deposit

    Signature of Licensing Officer

    *********
    DETAILS OF WORKERS EMPLOYED BY THE CONTRACTOR

    Name of Contractor:

    Sl No. Name Address


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    Signature of the Contractor


    With Seal

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