FORM IV (See Rule -2 (2) ) APPLICATION FOR LICENCE 1. Name and address of the contractor. (Including father's name) 2. Particulars of establishment where contract labour is employed. 3. (i) Name and address of the establishment. (ii) No. and date of certificate of registration under the Act. (iii) Name and address of the Principal employer. (iv)Nature of process of operation of quack for which contract labour to be employed in the establishment. (v)Nature of process operation of work in which establishment engaged. (vi)Duration of proposed contract work (give proposed date of commencement & ending) (vii)Name and address of the Agent or manager of the contractor at the establishment. (viii)Maximum no.of employees or proposed to be employed as contract labour in the establishment. 4. Whether the contractor has worked in any other Establishment within the past three years.(if, so give details of the period of employment and nature of work.) 5. The estimate value of the contract work. 6. No and date of the Treasury receipt enclosed. Date.______________________ Signature of the Contractor.
