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The document is an application form for registration of an establishment, requiring details such as the name, address, nature of business, and employer information. It includes a self-declaration affirming compliance with labor laws and the accuracy of the provided information. The applicant must also acknowledge their responsibility for legal actions related to labor law compliance and declare adherence to the Gujarat Shops and Establishments Act, 2019.

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navdeepdobariya96
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3 views

Form pick assignment

The document is an application form for registration of an establishment, requiring details such as the name, address, nature of business, and employer information. It includes a self-declaration affirming compliance with labor laws and the accuracy of the provided information. The applicant must also acknowledge their responsibility for legal actions related to labor law compliance and declare adherence to the Gujarat Shops and Establishments Act, 2019.

Uploaded by

navdeepdobariya96
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

Form-A

(See rule 3)
PHOTO
APPLICATION FOR REGISTRATION

1 Name of the Establishment :-

Postal Address and Situation of


2 :-
Establishment
3 Date of Commencement of Business :-

Nature of Business Whether Establishment


4 falls under Public Sector or Private Sector :-

Address of the office, storeroom, goddown,


workplace, if any, other than above address
5 (should be field only when Office, :-
ShowRoom etc. is not separately registered
under the act):
6 Name of the Employer :-

7 Residential Address of the Employer :-

Status/Designation :-

Mobile Number and E-mail ID :-

8 (1) Category of Establishment


:-
(Shop/ Establishment)

(b) Type of Organization i.e Proprietor,


Partnership, LLP, :-
Company/Trust/Cooperative Society/Board

9 Details of the partner Name and Mobile No. and


/Director/Trustee/Board and Society :- Residential Address e-mail Id
Members

10 Name of the members of employer's Name of the Person Relation


:-
family employed in the establishment
11 ManPower/ Workers Details :- Men Women

Persons working in
Managerial/Supervisory/Confidential :-
capacity
No. of workers other than above :-

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12 No. of apprentices under the
:-
Apprentices Act, 1961 (52 of 1961)

No. of contract labour :-

No. of part-time labour :-

Total :-

S elf-Declaration

I/We hereby solemnly affirm and state that the business which I/We have started is not banned or
prohibited by any labour laws. Rules, or Order of any labour Court or any competent authority
under labor laws and the premises where I/We are conducting the said business is free from
violating of any labour laws. Rules, Order of any labour Court or any Competent Authority under
labour laws.

I/We hereby declare that the information provided above is true and correct to the best of my
personal knowledge, information and belief. I am fully aware about the consequences of giving
false information. If the information is found to be false, I shall be liable for prosecution and
punishment under the Indian Penal Code (45 of 1860) and/or any other law applicable thereto.

I/We have obtained necessary labour laws related licenses. Permissions. Permit for the conduct of
this business and place of business from the appropriate Authority.

I/We shall be responsible and liable for legal action if the business is conducted without proper
labour laws related license. Permission, permit from the appropriate Authority.

I/We hereby declare that the copies attested by me are true copies of original documents. I am
well aware of the fact that if the copies are found false/forget. I shall be liable for prosecution and
punishment under the Indian Penal Code (45 of 1860) and/or any other law applicable thereto.

I/We undertake to abide by the provisions of the Gujarat Shops and Establishments (Regulation
of Employment and Condition of service) Act, 2019 (Guj.4 of 2019) and the Rues and orders
passed there under by any Authority.

Date:
Place:
Name and Signature of Applicant

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