Logo of Karnataka Labour Department,Government of Karnataka
(Labour Department Online Services)

Form-I

[See sub-rule (1) rule 15 & Section 7]
APPLICATION FOR REGISTRATION OF ESTABLISHMENTS EMPLOYING BUILDING WORKERS
If you already filled the details partially, Please Enter the Temporary Application number
Name of the establishment where building or other construction work is to be carried on *
 
location of the establishment where building or other construction work is to be carried on :*
 
 
Postal address of the establishment :*
 
 
Full name of the establishment, if any :*
 
Permanent address of the establishment, if any : *
 
 
Labour LO District :*
 
LO Sub Division :*
 
 
LO Jursidiction Taluk:*
 
 
Mobile Number :*
   
Email ID:*
 
 
 
Full name of the manager or person responsible for supervision and control of the establishment:*
 
Address of the manager or person responsible for supervision and control of the establishment:*
 
 
Nature of building or other construction work carried/ is to be carried on in the establishment:*
 
Maximum number of building workers to be employed on any day:*
 
 
Estimated date of commencement of building or other construction work:*
 
dd-MM-yyyy  
Estimated date of completion of the building or other construction work:
 
dd-MM-yyyy  
 
No of Building Workers:*
 
Online Registration Fee (In Rupees):*
 
Sector:
 

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. List with full address and Identity Card of Partners/Directors/Owners/Occupiers /Proprietor of the Organization:
 
 
3. Sanctioned Plan approved by local Authority :*
 
 
4.Advance Cess Paid Details/ Estimated Cost
 
 
5.Copy of Memorandum of Association (MOA) / ROC in case of Private / Public Companies:
 
 
I hereby declare that the particulars given above are true to the best of my knowledge and belief :*
I undertake to abide by the provisions of the Building and other Construction Workers Regulation of Employment and Conditions of service Act 1996, and the Rules made thereunder
The Applicant shall scan his/her latest Signature file with max. size 50kb in .jpg Format
 
Date:
place:
Signature of the Employer: