Service Description
Application Form
Apply For Service
FORM-21
Application For Annual Return Form
UBIN Details
UBIN
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Where to Apply
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Please Select
BAKSA
BARPETA
Biswanath
BONGAIGAON
CACHAR
CHARAIDEO
CHIRANG
DARRANG
DHEMAJI
DHUBRI
DIBRUGARH
DIMA HASAO
GOALPARA
GOLAGHAT
HAILAKANDI
HOJAI
JORHAT
KAMRUP
KAMRUP METRO
KARBI ANGLONG
KARIMGANJ
KOKRAJHAR
LAKHIMPUR
MAJULI
MARIGAON
NAGAON
NALBARI
SIVASAGAR
SONITPUR
SOUTH SALMARA MANCACHAR
TINSUKIA
UDALGURI
WEST KARBI ANGLONG
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Factory Details
For the year ending 31st December
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Registration Number of Factory
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Name of Factory
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Name of the Occupier
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Name of the Manager
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Full postal address of factory
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Address Line 1
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Address Line 2
Address Line 3
Country
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Please Select
India
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Central African Republic
Cape Verde
Chad
Chile
China
Colombia
Comoros
Conga
Costa Rica
Côte d Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Korea,Democratic People s Republic of
Congo, the Democratic Republic of the
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People s Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia, Federated States of
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Republic of Korea
Republic of Moldova
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Tajikistan
Thailand
The former Yugoslav Republic of Macedonia
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United Republic of Tanzania
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam
Yemen
Zambia
Zimbabwe
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State
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Please Select
ANDAMAN AND NICOBAR ISLANDS
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHHATTISGARH
DADRA AND NAGAR HAVELI
DAMAN AND DIU
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
LAKSHADWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ODISHA
PUDUCHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTARAKHAND
UTTAR PRADESH
WEST BENGAL
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District
Please Select
Postal / Zip Code
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Full postal address of Applicant
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Address Line 1
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Address Line 2
Address Line 3
State
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Please Select
ANDAMAN AND NICOBAR ISLANDS
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHHATTISGARH
DADRA AND NAGAR HAVELI
DAMAN AND DIU
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
LAKSHADWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ODISHA
PUDUCHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTARAKHAND
UTTAR PRADESH
WEST BENGAL
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Country
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Please Select
India
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Central African Republic
Cape Verde
Chad
Chile
China
Colombia
Comoros
Conga
Costa Rica
Côte d Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Korea,Democratic People s Republic of
Congo, the Democratic Republic of the
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People s Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia, Federated States of
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Republic of Korea
Republic of Moldova
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Tajikistan
Thailand
The former Yugoslav Republic of Macedonia
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United Republic of Tanzania
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam
Yemen
Zambia
Zimbabwe
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District
Please Select
Postal / Zip Code
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Mobile Number
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E-Mail
Nature of Industry
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Number Of Workers And Particulars Of Employment
Number of days worked in the year
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Number of mandays worked in the year
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Men
Women
Children
Average number of workers employed daily ( See Explanatory note)
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Adults
Men
Women
Adolescents
Male
Female
Children
Boys
Girls
Total number of man-hours worked including over-time
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Men
Women
Children
Average number of hours worked per week (See explanatory note)
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Men
Women
Children
Does the factory carry out any process or operation declared as dangerous under Section 87 ? (See Rule 94)
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Yes
No
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If so, give the following information.
Sl No
Name of the dangerous process or operations carried on
Average number of persons employed daily in each of the processes or operations given in column 1
Sl No
Name of the dangerous process or operations carried on
Average number of persons employed daily in each of the processes or operations given in column 1
Total number of workers employed during the year.
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Men
Women
Children
Number of worker who were entitled to annual leave with wages during the year
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Men
Women
Children
Number of worker who were granted leave during the year
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Men
Women
Children
Number of workers who were discharged or dismissed from the service or quit employment or were superannuated or who died while in service during the year
Number of such workers in respect of whom wages in lieu of leave were paid
Number of Safety Officers required to be appointed as per Notification under Section 40-B
Number of Safety Officer appointed
Is there an Ambulance Room provided in the factory as required under Section 45 ?
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Yes
No
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Is there a Canteen provided in the factory as required under Section 46 ?
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Yes
No
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Is the Canteen provided managed/run.
Departmentally?
Through a contractor?
Are there adequate and suitable Shelters or Rest Rooms Provided in factory required under Section 47 ?
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Yes
No
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Is there a creche provided in the factory as required under Section 48 ?
Yes
No
Number of Welfare Officers to be appointed as required under Section 49
Number of Welfare Officers appointed
Factory Accidents Details
Total number of accidents
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Fatal
Non Fatal
Accidents in which workers returned to work during the year to which this relates
1. Accident (workers injured) occurring during the year in which injured workers returned to work during the same year.
2. Accidents (Workers injured) occurring in the previous year in which injured workers returned to work during the year to which this return relates.
a. Number of accidents
a. Number of accidents
b. Mondays lost due to accidents
b. Mondays lost due to accidents
3. Accidents (workers injured) occurring during the year in which injured workers did not return to work during the year to which this return relates
a. Number of accidents
b. Mondays lost due to accidents
Suggestion Scheme
Is a Suggestion Scheme in operation in the factory
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Yes
No
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If so, the number of suggestion
Award Details
Amount awarded in case prize during the year
Total amount awarded
Value of the maximum cash prize awarded
Value of the minimum cash prize awarded
Details For Notifications
Applicant Name
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Mobile Number
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E-Mail
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