FORM X [See Rule 32(2)] Application for Temporary License 1. Name and address of the Contractor. (Include his father's name in case of individuals). 2. Date of Birth and age ( in case of individuals). 3. Particulars of establishment where contract labour is to be employed : (a) Name and Address of the Establishment; (b) Type of business, trade, industry, manufacture of occupation which is carried on in the establishment; (c) Name and address of the Principal Employer 4. Particulars of contract Labour: (a) Nature of work in which contract labour is to be employed in the establishment; (b) Duration of the proposed contract work (give particulars of proposed date of commencing and ending); (c) Name and address of the Agent or manger of Contractor at the (d) Maximum number of contract Labour proposed to be employed in the establishment on any day. 5. Whether the contractor was convicted of any offence with in the preceding five years? If so, give details. 6. Whether there was any order against the contractor revoking or suspending license or forfeiting security deposits in respect of an earlier contract? If so the date of such order? Page 61 of 151 7. Whether the contractor has worked in any order establishment within the past five years? If give details of the principal employer, establishment and nature of work. 8. Amount of license fee paid No. of Treasury Challan or the Crossed Postal Order and Date. 9. Amount of Security deposit -Treasury Receipt or Crossed Postal Order No. and Date. I here by declare that the particulars given above are true to the best of my Knowledge and belief. Place: Signature of the Applicant (Contractor). Date: To be filled in the office of the licensing Officer. Date of Receipt the application with Challan for fee/Security Deposit. Signature of the Licensing Officer Page 62 of 151
