छत्तीसगढ़ शासन श्रम विभाग

Now the Provision of Renewal of Licence has been eliminated.Licence Shall be valid for the duration of work order

Application For License Under Inter State Migrent Workmen ACT 1979

FORM-V
[See C.G. Rules 7(1)]
Application For License For Recreuitment
(Inter State Migrent Workmen ACT 1979)

Particular's of Contractor's Establishment

Name*

Address*

Dist*

Land Mark*

State*

Rural/Urban*

Block Name*

E.P.F. Registration No

E-Mail ID*

Pin Code*

* *

Date of Commencement of Work/Proposed Date *

If Registered Under Companies ACT*

YES

Particulars of contractor in Person

Contractor Name*

Father's Name *

Age *

* *

Designation*

Date of Birth *

Postal Address *

State*

Rural/Urban*

Pin Code*

Dist*

Block Name*

Adhar Number *

Pan Card Number *

* *

Email-ID *

Mobile Number *

* *

Particulars of Agent/Manager of Contractor

Full Name*

Father's Name*

State*

Designation*

Postal Adress*

Dist*

Rural/Urban*

Pin Code*

* *

Pan Card Number*

* *

Mobile Number*

* *

Block Name*

Adhar Number *

E-Mail ID*

Information on Establishment of Principal Employer

Category of Establishment

Name*

Land Mark*

State*

कार्य

Address*

Dist*

Rural/Urban*

Pin Code*

* *

Registration No Under
Contract Labour ACT *

Block Name*

E-mail ID*

E.P.F. Number*

Registration No Under Labour Welfare Fund Act

Details of the deposits of C.G. Labour Welfare Board

Whether Contractor was convicted of any offence withing preceding five years?

Select One*

YES

Whether any order Passedagainst the Contractor Revoking/Suspending License/Forfeiting Security Deposit ?

Select One*

YES

Whether the Contractor Worked in any Establishment within Five Year?

Select One*

YES

Whether Certificate issued By Principal Employer In FORM -V enclosed

Upload Form VI

Download FOrm FORM -VI Formate

Payment of License Fee

E-Chalan (Chalan Head =>0230 श्रम और रोजगार 106 संविदा श्रमिक (विनिमय उन्मूलन) एक्ट के अंतर्गत प्राप्तियां)

E-Chalan Number

Help for e-challan

License Fee

* *

Security Deposit

E-Chalan(Chalan Head =>K Deposite Advance (6) Deposite Not Bearing Intrest 8443 Civil Deposite 116 Deposite under Various Contacts Labour /Regulation and Abolition/Act 1970 (Security Deposite)

E-Chalan Number

Help for e-challan

Security Deposit

* *

User Detail

User Name

Mobile Number

* *

Password

Telephone Number

I hereby declare that the particulars given and document uploaded here in above are true to the best of my knowledge and belief

S.No.	No. of Labour	Fees
1	Below 20	60.00
2	Above 20 and Below 50	100.00
3	Above 50 Below 100	200.00
4	Above 100 Below 200	400.00
5	Above 200 Below 400	800.00
6	Above 400	1500.00

Now the Provision of Renewal of Licence has been eliminated.Licence Shall be valid for the duration of work order

Application For License Under Inter State Migrent Workmen ACT 1979

FORM-V [See C.G. Rules 7(1)] Application For License For Recreuitment (Inter State Migrent Workmen ACT 1979)

Particular's of Contractor's Establishment

Particulars of contractor in Person

Particulars of Agent/Manager of Contractor

Information on Establishment of Principal Employer

Whether Contractor was convicted of any offence withing preceding five years?

Whether any order Passedagainst the Contractor Revoking/Suspending License/Forfeiting Security Deposit ?

Whether the Contractor Worked in any Establishment within Five Year?

Whether Certificate issued By Principal Employer In FORM -V enclosed

Payment of License Fee

Security Deposit

User Detail

FORM-V
[See C.G. Rules 7(1)]
Application For License For Recreuitment
(Inter State Migrent Workmen ACT 1979)