Application for license of a contractor (s) for employment of migrant workmen in form V under Section 8 (1) (b) of the Interstate Migrant Workmen (R.E & C.S) Act, 1979 and Rule 7 (2) of the Assam Rules.

UBIN Details

Note: In case, UBIN is not available,kindly apply for it in the Common Application Form first.

UBIN *

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Mobile number *

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Select where you want to submit your application *

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Assistant Commissioner of Labour

Office of the Labour Officer

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Assistant Commissioner of Labour

Office of the Labour Officer

Applicant details for SMS notification

Name of the applicant *

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Mobile Number of the applicant *

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1.Name and address of the contractor (including his father's/husband's name in case of individuals)

Full name of contractor *

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Father's name

Street Name 1 *

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Street Name 2

Village / Town *

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Country *

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State *

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District

Postal / Zip Code *

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Mobile number of the contractor *

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2. Date of birth and age (in case of individual)

Date

Age

3. Particulars of establishment where migrant workmen are to be employed

(a) Name and address of the establishment

Name of the establishment *

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Street Name 1 *

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Street Name 2

Village / Town *

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Country *

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State *

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District

Postal / Zip Code *

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(b) Type of business, industry, manufacture or occupation, which is carried on in the establishment *

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(c)Number and date of certificate of registration of the establishment under the Act

Registration Number *

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Date *

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(d) Full name and address of the Principal Employer

Full Name of the Principal Employer *

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Street Name 1 *

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Street Name 2

Village / Town *

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Country *

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State *

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District

Postal / Zip Code *

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4. Particulars of migrant workmen

(a) Nature of work in which migrant workmen are employed or are to be employed in the establishment *

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(b) Duration of the proposed contract work (give particulars of proposed date of commencing and ending)

Date of Commencing *

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Date of Ending *

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Full Name of the Agent/Manager

Street Name 1 *

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Street Name 2

Village / Town

Country

State

District

Postal / Zip Code

(d) Maximum number of migrant workmen proposed to be employed in the establishment on any date *

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No. of months workers is proposed to engage *

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Section

(e) Name(s) and address of the Directors/Partners in case of companies and firms

Full Name

Street Name 1

Street Name 2

Village / Town

District

Pin Code

Full Name

Street Name 1

Street Name 2

Village / Town

District

Pin Code

(f) Name(s) and address (es) of the person (s) in-charge of and responsible to the Company/firm for the conduct of the business of the company/firm, as the case may be.

Full Name

Street Name 1

Street Name 2

Village / Town

District

Pin Code

Full Name

Street Name 1

Street Name 2

Village / Town

District

Pin Code

Section

5. Whether the contractor was convicted of any offence within the preceding five years. If so, give details

6. Whether there was any order against the contractor revoking or suspending licence or forfeiting security deposits in respect of an earlier contract, if so, the date of such order

7. Whether the contractor has worked in any other establishment within the past five years. If so, give details of the principal employer establishment and nature of work

8. Whether a certificate by the principal employer in Form-VI is enclosed

Mode of Application Fees Payment *

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Please tick the checkbox below and proceed *

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

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Section

Application Fees

Security Fees