FORM   IV

 (See Rule   -2  (2)  )

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APPLICATION  FOR LICENCE

 

    1.     Name and address of the contractor.

         (Including father's name)

 

    2.     Particulars of establishment where

         contract labour is employed.

 

    3.   (i) Name and address of the establishment.

         (ii) No. and date of certificate of registration

              under the Act.

         (iii) Name and address of the Principal employer.

         (iv)Nature of process of operation of quack for which

              contract labour to be employed in the establishment.

         (v)Nature of process operation of work in which

             establishment engaged.

         (vi)Duration of proposed contract work (give

              proposed date of commencement & ending)

         (vii)Name and address of the Agent or manager of the

               contractor at the establishment.

         (viii)Maximum no.of employees or proposed to be

               employed as contract labour in the establishment.

 

    4.     Whether the contractor has worked in any other

         Establishment within the past three years.(if, so

         give details of the period of employment and nature

         of work.)

 

     5.  The estimate value of the contract work.

 

     6.     No and date of the Treasury receipt enclosed.

 

 

Date.______________________                                                                   Signature of the Contractor.

Place._____________________

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