The Beedi & Cigar Workers (Conditions of Employment) (Karnataka) Rules, 1969
 F O R M – ‘I’[See Rules 3 and 4]

Application for Grant of Licence for the Financial Year 2018

             (Please go through the Instructions carefully, available on the Home Page of this Website before entering the information for Online Application)       
                    If you already filled the details partially, Please Enter the Temporary Application number       
Full Name of the industrial premises:*   Full postal address and situation of the industrialpremises:*  
Full address to which communications relating to the industrial premises should be sent:*   Full address of the applicant:*  
Maximum number of employees proposed to be employed on any one day during the financial year *   Full Name of the person who shall be the employer for the purposes of the Act:*  
Residential address of the person who shall be the employer for the purposes of the Act:*   If the employer is a partnership company, etc., full name and residential address of other partners or directors, etc.: (See Note 1 at the end):*  

 
Division :*   District/Sub Division :*  
Taluk:*  
Mobile Number :*     Email ID:*  
 
Financial resources of the employer (e.g., particulars and value of movable and immovable properties, bankreference, income-tax assessment, etc.): *   Whether the employer is a trade mark holder registered under the Trade and Merchandise Marks Act, 1958:*  
Value of beedis or cigars or both manufactured at the industrial premises during the preceding financial year:*   Previous experience of the applicant in the industry:*  
Source of obtaining tobacco:   Whether the beedis or cigars or both manufactured by the applicant will be sold and marketed by himself or through a proprietor or a registered user of a trade mark registered under the Trade and Merchandise Marks Act, 1958, or any other person  
Whether the plans of the premises are enclosed:   Amount of fee Rs:  
Estimated date of commencement of work:*  
dd-MM-yyyy  
Estimated date of completion of work:*  
dd-MM-yyyy  
Power Machinery

Document Required to be Submitted at the time of online Registration


(The Applicant shall scan his/her latest documents with max. size 250kb for each document in .pdf format and upload the same, while submitting the Online application for registration, The applicants shall not upload any other documents (except the below specified documents) at the stage of submitting the online application).
1. Authentic Identity Card of the Applicant (Like EPIC,Driving Licence,Pan Card,Aadhar Card,Passport,Bank OR Post Office Passbook,Ration Card,Railway Identity Card,Identity Card for the Disabled):*  
2. Copy of the Registration / Challan or ESI/PF/ST/Registration Certificate either under Factories Act or Shop Act, GST:*  
3. List with full address and Identity Card of Partners/Directors/Owners/Occupiers/Proprietor of the Organization:*  
4. Applicants / Authorised Signatories Full Name, Address, Designation with Seal:*  
5. Declaration regarding Non-employment of Child Labour:*  
6. Copy of Memorandum of Association (MOA) / ROC in case of Private / Public Companies:*  
7.Blue print of the Building:*  
Particulars of Treasury Receipt enclosed(Name of the treasury) :*
             Note: 1: Where an industrial premises are run or proposed to be run by a contractor for or on behalf of another person or persons or Company etc., the said other person or persons or Company, etc., is under the Act the employer and particulars to be entered for “employer” in the Form should be or in regard to such person persons or Company, etc.
2 . (1) This form shall be completed in ink in block letters or typed. (2) If any person named against Item 5 is a minor, the fact shall be stated clearly.
I hereby declare that the particulars given above are true to the best of my knowledge and belief. :*
(Please upload the Signature file in JPEG format and less than 50KB)
Place: Date: Signature of the Applicant:*

 
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