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NOTE: You can download Form VI format from the portal under downloads option before filling the application. After filling Form VI please scan and upload under document upload option at SL No:8
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| Name of the Contractor :*
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Address of the Contractor*
(including father’s name in the case of individuals):
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| Labour ALC Division :*
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ALC District/Sub Division :*
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| ALC Jursidiction Taluk:*
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Ward/Corporation/Houbli :*
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| Date of birth(in case of individuals): |
(MM/dd/yyyy)
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Age (Incase of Individuals):
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| Mobile Number :*
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Office Number :*
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| Email-ID :*
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Particulars of Establishment where migrant workmen are to be Employed *
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| Enter Registration Number :*
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| Name of the Establishment :*
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Address of Establishment :*
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| Type of Business, trade, industry, manufacture or occupation which is carried on in the estabishment:*
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Number and Date of Certificate of Registration of the Establishment under the Act
;*
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| Name of the Principal Employer :*
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Address of the Principal Employer :*
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Particulars of Contractors
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| Nature of work in which migrant workmen is employed or are to be employed in the Establishment :*
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Duration of the proposed Contract work (give particulars of proposed date of commensing
and ending) :*
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| Contract Commencement Date :*
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MM-dd-yyyy
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Contract End Date :*
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MM-dd-yyyy
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| Names of the Directors/Partners (in case of companies and firms):*
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Addresses of the Directors/Partners (in case of companies and firms):*
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| Names of the persons in charge of and responsible to the company/firm, for the conduct of the business of the company/firm, as the
case may be.:*
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Addresses of the persons in charge of and responsible to the company/firm, for the conduct of the business of the company/firm, as the
case may be.:*
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| Maximum Number of migrant workmen proposed to be employed in the establishment on any date:*
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Whether the contractor was convicted of any offence, within the preceding five years,
if so, give details :*
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| Whether there was any order against the contractor revoking or suspending Licence
or forefeiting security deposites in respect of an earlier contract. If so, the
date of such order :*
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dd-MM-yyyy
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Whether the contractor has worked in any other establishment within the past five years. If so, give details of the Principal Employer, establishments and nature of work :*
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| Whether a certificate by the Principal Employer in Form ‘VI’ is enclosed :*
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