The Contract Labour (Regulation & Abolition) (Karnataka) Rules, 1974
 F O R M – ‘IV’ [See Rule 25 (I)]

Application for Licence

NOTE: You can download Form V format from the portal under downloads option before filling the application. After filling FormV
please scan and upload under document upload option at SL No:8
             (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       
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:*  
Date of birth : (MM/dd/yyyy)   Age (Incase of Individuals):
Mobile Number :*       Office Number :*  
Email-ID :*    
Particulars of Establishment where Contract Labour is 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; and employed in the establishment on any date of the preceeding 5 years if so, give details:*   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 Contract Labour is Employed or is to be Employed in the Establishment :*  
Duration Of the proposed Contract work (give particulars of proposed date of commensing and ending) :*
Contract Commencement Date :*     Contract End Date :*    
Name Of the Agent or Manager of Contractor at the worksite:*   Address Of Agent or Manager of Contractor at the worksite:*  
No of Workers (Female) :*   No of Workers (Male):*  
Maximum Number Of Contract Labour 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 :* Whether the contractor has worked in any other establishment within the past five years. If so, give details of the Principal Emplo yer, establishments and nature of work :*
Whether a certificate by the Principal Employer in Form ‘V’ 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 & 50kb of signature file in .jpg 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 V (preferably on the letter head of the Principal Employer).You can download Form V format from the website under downloads option:*  
Particulars of Treasury Receipt enclosed(Name of the treasury) :*
Number of Workers :*   Amount Of Licence Fee :*
Security Deposit (@ Rupees 50/- per Worker) Enter Number Of Workers:*   Security Deposit amount for Online Registration :*
Declaration: I hereby declare that the details given above are correct to the best of my knowledge and belief.
Date:
Place:
Signature Of The Applicant(Contractor):*

 
                                                    
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