The Inter-State Migrant Workmen (Regulation of Employment & Conditions of Service) Central Rules, 1980
 F O R M – ‘V’ [See Rule 7 (2)]

Application for Licence for Employment

             (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       
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
Name of the Contractor :*   Address of the Contractor*

(including father’s name in the case of individuals):

Labour ALC Division :*   ALC District/Sub Division :*  
ALC Jursidiction Taluk:*   Ward/Corporation/Houbli :*
Date of birth(in case of individuals): (MM/dd/yyyy)     Age (Incase of Individuals):
Mobile Number :*       Office Number :*  
Email-ID :*    
Particulars of Establishment where migrant workmen are to be Employed *
Enter Registration Number :*  
Name of the Establishment :*   Address of Establishment :*  
Type of Business, trade, industry, manufacture or occupation which is carried on in the estabishment:*   Number and Date of Certificate of Registration of the Establishment under the Act ;*
Name of the Principal Employer :*   Address of the Principal Employer :*  
Particulars of Contractors
Nature of work in which migrant workmen is employed or are to be employed in the Establishment :*  
Duration of the proposed Contract work (give particulars of proposed date of commensing and ending) :*
Contract Commencement Date :* MM-dd-yyyy     Contract End Date :* MM-dd-yyyy    
Names of the Directors/Partners (in case of companies and firms):*   Addresses of the Directors/Partners (in case of companies and firms):*  
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.:*   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.:*  
Maximum Number of migrant workmen proposed to be employed in the establishment on any date:*   Whether the contractor was convicted of any offence, within the preceding five years, if so, give details :*
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 :* dd-MM-yyyy   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 :*
Whether a certificate by the Principal Employer in Form ‘VI’ is enclosed :*

Documents required to be submitted at the time of online Licence Application

(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 Licence, 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 Postoffice Passbook,Ration Card,Railway Identity Card,Identity Card for the Disabled):*  
2.Certified Copy of Agreement / Contract between Principal Employer and the Contractor:*  
3. List with full address and Identity Card of Partners/Directors/Owners/Occupiers/Proprietor of the Organization:*  
4. Copy of Memorandum of Association (MOA) / ROC in case of Private / Public Companies:  
5. Duly filled in and signed Form VI (preferably on the letter head of the Principal Employer).You can download Form VI format from the website under downloads option:*  
6.Native State Certificate:
Particulars of Treasury Receipt enclosed(Name of the treasury) :*
Number of Workers :*   Amount of Licence fee :*
Enter the Security Deposit approx amount:* Before enter the Amount Please read (The security deposit, as per Rule-10 under the act shall be an amount not exceeding 40% of the factors listed under sub rule(1) of Rule 10.)
Security Deposit amount for Online Licence :*
Declaration: I hereby declare that the details given above are correct to the best of my knowledge and belief.
(Please upload the Signature file in JPEG format and less than 50KB)
Signature of the Applicant(Contractor):*

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