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    Form Iv & V

    Uploaded by

    Shagir Ali
    The document is an application form for a contractor license under the Contract Labour (Regulation and Abolition) Act and Rules. It contains 10 sections requesting information such as the contractor's name and address, details of the establishment where contract labor will be employed, nature of the contract work, maximum number of contract laborers to be employed, any past convictions or license revocations, and confirmation from the principal employer in Form V that they will comply with the Act and Rules in respect to the contractor's employment. The contractor declares that the details provided are correct to the best of their knowledge and signs the application, which must be accompanied by fees/deposit and Form V from the principal employer.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Form Iv & V

    Uploaded by

    Shagir Ali
    75 views3 pages
    The document is an application form for a contractor license under the Contract Labour (Regulation and Abolition) Act and Rules. It contains 10 sections requesting information such as the contractor's name and address, details of the establishment where contract labor will be employed, nature of the contract work, maximum number of contract laborers to be employed, any past convictions or license revocations, and confirmation from the principal employer in Form V that they will comply with the Act and Rules in respect to the contractor's employment. The contractor declares that the details provided are correct to the best of their knowledge and signs the application, which must be accompanied by fees/deposit and Form V from the principal employer.

    Original Description:

    FORM IV & V

    Original Title

    FORM IV & V

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    © © All Rights Reserved

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    The document is an application form for a contractor license under the Contract Labour (Regulation and Abolition) Act and Rules. It contains 10 sections requesting information such as the contractor's name and address, details of the establishment where contract labor will be employed, nature of the contract work, maximum number of contract laborers to be employed, any past convictions or license revocations, and confirmation from the principal employer in Form V that they will comply with the Act and Rules in respect to the contractor's employment. The contractor declares that the details provided are correct to the best of their knowledge and signs the application, which must be accompanied by fees/deposit and Form V from the principal employer.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    75 views3 pages

    Form Iv & V

    Uploaded by

    Shagir Ali
    The document is an application form for a contractor license under the Contract Labour (Regulation and Abolition) Act and Rules. It contains 10 sections requesting information such as the contractor's name and address, details of the establishment where contract labor will be employed, nature of the contract work, maximum number of contract laborers to be employed, any past convictions or license revocations, and confirmation from the principal employer in Form V that they will comply with the Act and Rules in respect to the contractor's employment. The contractor declares that the details provided are correct to the best of their knowledge and signs the application, which must be accompanied by fees/deposit and Form V from the principal employer.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 3

    FORM - IV

    APPLICATION FOR LICENCE


    [(Rule 21(1)]

    Name and address of the contractor (including his


    1. :
    father's name in case of individual).

    2. Date of birth and age (incase of individuals). :


    Particulars of Establishment where contract labour
    3. :-
    is to be employed

    :
    a) Name and address of the establishment
    b) Type of business, trade, industry, manufacture
    or occupation, which is carried on in the :
    establishment.
    c) Number and date of certificate of registration of
    :
    the establishment under the Act.
    d) Name and address of the Principal Employer :
    4. Particulars of contract labour :-
    a) Nature of work in which contract labour is
    employed or 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 Manager of
    :
    Contractor at the work-site.
    d) Maximum number of contract labour proposed
    :
    to be employed in the establishment on any date
    Whether the contractor was convicted of any
    5. offence within the preceding five years. If so, give :
    details.
    Whether there was any order against the
    contractor revoking or suspending license or
    6. :
    forfeiting security deposits in respect of any 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
    7. :
    details of the Principal Employer, establishments,
    and nature of work.
    Whether a certificate by the Principal Employer in
    8. :
    Form V is enclosed.
    Amount of licence fee name of the Bank, demand
    9. :
    draft No. and date.
    Amount of security deposit name of the Bank,
    10 :
    demand draft No. and date.
    Note: The application shall be accompanied by demand draft and the challan for the
    appropriate amount and a certificate in Form V from the Principal Employer
    ……………………………………………………………………., date of the receipt of the
    application with “demand draft” and the challan for fees/security deposit.

    DECLARATION

    I hereby declare that the details given above are correct to the best of my knowledge and
    belief.

    Place:
    Signature of the Applicant
    Date: (Contractor)

    Note: The application should be accompanied by a Treasury Receipt for the appropriate
    amount and a certificate in Form V from the Principal Employer

    (To be filled-in the office of the Licencing Officer)


    Date of receipt of the application with challan for fees/security deposit
    FORM V
    [(Rule 21(2)]
    Form of Certificate by Principal Employer

    Certify that we have engaged the applicant M/s. XYZ as a Contractor in our
    establishment. We undertake to be bound by all the provisions of the Contract Labour
    (Regulation and Abolition) Act, 1970, and Contract Labour (Regulation and Abolition)
    Karnataka Rules, 1974, in so far as the provisions are applicable to us in respect of the
    employment of Contract Labour by the applicant in our establishment.

    For ______________

    GM (HR)

    Date :
    Place :

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