FORM – A

APPLICATION FOR INTEGRATED REGISTRATION OF ESTABLISHMENT UNDER LABOUR LAWS REGISTRATION / LICENSE REQUIRED UNDER (Specify the Act with tick mark) 1 A.P. Shops & Establishments Act, 2 Motor Transport Workers Act, 1966 3 Contract Labour (R&A) Act, 1970 (Principal employer Establishment & Contractor Establishment) Inter State Migrant Workmen (RE&CS) Act, 1979 (Principal employer Establishment & contractor Establishment) 5 Building and Other Construction Workers (RE&CS) Act, 1996 6 Payment of Gratuity Act, 1972 7 Beedi & Cigar Workers (COE) Act, 1966 ESTABLISHMENT DETAILS 1 Name of the Establishment Classification of Establishment (Proprietor firm, Partnership firm, Pvt. Ltd, Public Ltd, Cooperative, Society etc.) Category of Establishment [Shop, Establishment, Commercial Establishment Motor Transport undertaking, Building or other construction Establishment, Contract Labour (Prl. Employer / Contractor) Establishment] 4 Address of establishment 5 Nature of Business / work / construction activity Date of commencement of business / work / construction / activity 7 Date of completion of work / construction / activity (if applicable) 8 Date of agreement 9 No .of transport vehicles 10 Whether Form-V/ Form-VI issued by Principal Employer 11. Agreement No/Plan approval No. 12 Date of agreement /Plan approval 13 Estimated cost of construction & other Details (in case of building or other construction work) 14 Details of contractors (Contract Labour Act/Inter State Migrant Workmen Act) 15 Details of contract works ( Contract Labour Act/Inter State Migrant Work men Act) 16 Total No. of Workers 17 Details of workers Regular Casual/ Badilli In case of beedi or cigar est. Male Female Male Female Industrial premises workers Home workers Male Female Male Female 18 Workers employed in shops &Esstts. Motor Transport Workers 20 Building & other construction workers Contract workers 22 Inter State Migrant Workers 23 Beedi & Cigar workers 24 Factory workers 25 Any other Category workers (specify the category EMPLOYER DETAILS (Enclose Passport size photo 26 Employer Name 27 Designation 28 Father/husband Name 29 Contact details Applicants Details 30 Applicant Name 31 Designation 32 Father /husband name 33 Contact details DECLARATION 34 I/we hereby declare that i/we have compiled with all relevant provisions of the Labour Acts applicable to the establishment. In case the information furnished above is found to be flase, misrepresented or suppressed and material information or evaded to furnish the information, I/we are liable for prosecution as per law besides cancellation of the registration / license granted Date Signature of the Employer Place Name & Designation of the Employer FORM-B COMBINED RETURN UNDER LABOUR LAWS AS ON 31 ST MARCH,20 (SECOND SCHEDULE (See sec.2 (d) and sec.4 (6) ANNUAL RETURN FOR THE YEAR ENDING 31 ST MARCH 1. Establishment Registration /License No.(LIN) 2. Establishment Name 3. Address 4. Establishment details 5. Classification of Establishment 6. Employer details 7. Establishment category 8. Nature of work/ activity/business/industry of the Establishment 9. Total. No. of Workers (furnish details in Annexure-1) 10 Details of payment of wages (furnish details in Annexure-2) 11 No. of the workers allowed to work overtime in the year 12 Amount of over time wages paid in the year 13. No.of workers covered under EDF 14 No. of workers covered under ESI 15 Details of Gratuity 16 Details of Bonus paid 17 Details of Employees Compensation paid 18 Leave eligibility 19 Details of payment of maternity benefit 20 Details of weekly off & other holidays allowed 21 Details of Welfare fund contribution 22 Details of settlements / Strikes/Lock-outs/Lay-offs/ Retrenchments closures etc. 23 Whether Works Committee constituted 24 Details of Trade Union existing in the establishment /industry 25 Details of contractors under Contract Labour Act 26 Details of contractors under Inter State Migrant Workmen Act 27 Whether muster roll, wages register etc, maintained 28 Whether appointment letters/Identity cards issued 29 Details of building or other construction work 30 Note:- Combined Annual Return for the ending 31 March shall be furnished online before 30 th June of the following year DECLARATION I/we hereby declare that /we have complied with all relevant provisions of the Labour Act applicable to the establishment. In the case the information furnished above is found to be false, misrepresented or suppressed any material information or evaded to furnish the information, I/we are liable for prosecution as per law besides cancellation of the registration /license granted. Signature of the Employer Date Place Name & Designation of the Employer ANNEXURE-I STATEMENT SHOWING CATEGORY WISE DETAILS OF WORKERS Establishment category/ worker category Direct workers Contract workers (contract labour act) Inter State migrant workers/ (Inter State workmen Act) Casual workers Seasonal workers Badli Workers Apprentice Others (Specify the category) Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Employees in shops (AP Shops & Estts. Act) Employees in Establishments (AP Shops & Essts Act) Employed in Factories Building and other construction Workers Sales promotion employees Plantation workers Beedi/ Cigar Workers Any other category worker/ Establishment (specify name ANNEXURE-2 STATEMENT OF DETAILS OF WAGES, BONUS PAID TO THE WORKERS DURING THE YEAR Sl. No Name of the worker Gender Establishment category (as vertical column in Annexure.1) Worker category (as specified in horizontal column in Annexure. 1) Designation Length of service Staff code No/Staff No/ Token No. EPF No. ESIC No DETAILS OF WAGES PAID PER MONTH Amount of bonus paid for the previous accounting year Whether covered under gratuity insurance scheme Basic wage VDA All other allowance Total wages (gross) Deduction Net wages paid 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 GOVERNMENT OF ANDHRA PRADESH LABOUR DEPARTMENT FORM-C CERTIFICATE OF REGISTRATION / LICENSE OF ESTABLISHMENT – Sec. 2(d) and 4(2) The Andhra Pradesh (Issuance of Integrated Registration and Furnishing of Combined Returns under various Labour Laws by certain Establishments) Act, 2015 1. Registration / License Number (LIN): 2. Name of the Establishment: 3. Address of the Establishment: 4. Employer Name: 5. Employer Address: 6. Category of Establishment: No. of workers Nature of Date of Date of completion work/business commencement 7. Date of issue: 8. Registration valid up to: It is hereby certified that the establishment has been Registered / Licensed under The Andhra Pradesh Issuance of Integrated Registration and Furnishing of Combined Returns under various Labour Laws by certain Establishments) Act, 2015. The License is granted for doing the work of ________________________ in the Establishment of (Principal Employer). REGISTERING / LICENSING OFFICER Note: 1.The Registration / License is valid from the date of Registration / License, to 31st March of the third year. Registration / License shall be renewed for the next three years before 31st March of the third year. 2. If the information furnished by the employer is subsequently found that any of the particulars furnished are wrong, or essential information is suppressed or misrepresented, the Registration / License is liable for cancellation without any notice and the employer will be liable for penal action as per law. 3. The Certificate of Registration / License is generated instantaneously, based on the information furnished by the employer in the application, which can be verified online in the mee-seva website at www.ap.meeseva.gov.in. ]