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3.
PRANAVI ELECTRONIC AND ELECTRICALS

8.

VILAS MAHADEV GHODKE

(9. ELECTRONIC AND ELECTRICALS

f:99-90-20??
faT:Nagpur
O|ulal YT:Office of the Additional Commissioner of Labour ,Nagpur, Address-R,8 AWing, Nevw Administrative
Building, Near Zilha Parishad Office, Nagpur -8Yoo09

908ccc89?R03 R3.0

Page 1 of I
 Form - F'
[See Rule 8]
APPLICATION FOR INTIMATION
Application ID 109888472203
Registration Certiflcate / Intimation
Receipt No. alqut Hi* / qTat H0G 2252300316924541
Dlvision /faTT
Nagpur
DistrictI e: Nagpur
Offlce Name Office of the Additional Commissioner of Labour ,Nagpur,
Address
2,4 A Wing, New Administrative Building., Near Zilha Parishad Office,
Nagpur -440 001
Name of the establishment /
3HFATYGYPRANAVI ELECTRONIC AND ELECTRICALS
Previous details of establish ment / New Registration

Postal address and situation of the

PLOT NO 17 GHOGALI ROAD GHOGALI, NEAR
Establishment / (31F14qoeT yl ) JANTA LAWN, NAGPUR,, NAGPUR (RURAL),
NAGPUR, 441111 ),ATR,441111
Mobile I Huat ,
9158904962
Email-id /$ -or 3HTT t
[email protected]
Date of commencement of business / 21/12/2017

Nature of Business / y H r Faq ELECTRONIC AND ELECTRICALS

Whether establishmnent falls under Private
public or private sector / 31T4GT

Total No. of Employee Men Women Transgender Total

1 0

Name of the Employer | HTeIhlë Aq VILAS MAHADEV GHODKE

Residentlal Address of the employer /PLOT NO 17 GHOGALI ROAD
GHOGALI.NEAR te 17 ala s alat, SIAI
JANTA LAWN,NAGPUR,NAGPUR afr, A ,,Alg (urrur ), ArrE,
(RURAL), NAGPUR,441111 441111
Resident Since | afdcT 2000

Status I Designatlon OWNER

Mobile No
9158904962
E-mall ID
[email protected]
Aadhar No
742385047896
Name of Manager / qFTYGT AT

Residentlal address of Manager /

Contact No

Fax No

Email-ID-H 3TT E
Aadhar No
 CSlADISNMent ( H1+yoll )

Category Of Establishment Type I ELECTRONIC AND ELECTRICALS

Type of organisation / 3TFTer yeaT Self Ownership (Proprietary)

Name of the member of employer's 0
family employed in the establlshment /0

Men / y4 Women / Transgender / GT

0

Self Declaration / Faluga

I VIKAS MAHADEV GHODKE, hereby solemnly affirm and state that the business
which | VIKAS MAHADEV GHODKE have
started is not banned or prohibited by any Act, Rules, Law or Order of any Court of Law or any
competent authority and the premises
where I VIKAS MAHADEV GHODKE, are conducting the said business is free from violation of any Act,
Rules, Order of any Court of
Law or any Competent Authority.

| VIKAS MAHADEV GHODKE, hereby declare that the information provided

above is true and correct to the best of my/our personal
knowledge, information and belief. I VIKAS MAHADEV GHODKE. am/are fully aware about the
information. If the
consequences of giving false
infomation is found to be false, | VIKAS MAHADEV GHODKE, shall be liable for procecution and
punishment under
the Indian Penal Code (45 of 1860) and lor any other lawW applicable thereto.

| VIKAS MAHADEV GHODKE, have obtained necessary licenses,

permissions. permit for the conduct of this businesS and the place of
business from the appropriate Authority.

| VIKAS MAHADEV GHODKE. shall be responsible and liable for legal action if the
business is conducted without proper licence,
permission, pemmit from the appropriate Authority. I/We sutbmit and declare that | VIKAS MAHADEV GHODKE, will not undertake any
illegal activity or any business prohibited in law in force in India.

IVIKAS MAHADEV GHODKE, declare that the place of business is not located in any area
wherein commencing / running of such
business is prohibited by any law or order of any Competent Authority.

IVIKAS MAHADEV GHODKE, hereby declare that the copies attested by me are true
copies of original documents. | VIKAS
MAHADEV GHODKE, am/are well aware of the fact that if the copies are found false/forged, lWe shall be
liable for procecution and
punishment under the Indian Penal Code (45 of 1860) and /or any other law applicable thereto.

| VIKASMAHADEV GHODKE, undertake to abide by the provisions of the Maharashtra Shops and Establishments
(Regulation of
Employment and Conditions of Service) Act, 2017 (Mah. LXI of 2017) and the Rules and orders passed thereunder by any
Authority.

3HTR/ 3MTR*a.

hll 3T3.

3HTE.
 VILAS MAHADEV GHODKE
Name and Signature of the Employer
INCOME TAX DEPARTMENT GOVT. OF INDIA
VILAS MAHADEV GHODKE

MAHADEV KARAN GHODKE

01/03/1976
Permanent Account Number

BXDPG6727K
17092016

Signature