GOVERNMENT OF MEGHALAYA
LABOUR DEPARTMENT

AUTO RENEWAL - APPLICATION FOR LICENSE FOR CONTRACTORS UNDER THE INTERSTATE MIGRANT WORKMEN ACT 1979

Please ensure you have following enclosures before proceeding to apply

1). Trading/Business license granted by the respective District Council(only for non-tribals) (optional)

2). Proof of Residence and Criminal antecedents, issued by District Magistrates/Additional District Magistrates and Superintendent of Police of the home State of each worker listed in form X (mandatory)

3). Form X affixed with epic and photograph of all the workmen (single file of all workmen) (mandatory)

4). Form VIII - License issued for recruiting workers from the state of recruitment (mandatory)

5). ST Certificate (only for tribals) (optional)

Renewal License

License No for which renewal is required *

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License Issued Date *

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License/ Renewal valid up to Date *

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Contractor's Details

Title

Name of the contractor *

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E-Mail Id of the contractor *

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Contact Number of the contractor *

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Father’s / Husband’s Name: (in case of individuals)

Upload contractor's Photo (Min 20Kb and Max 200Kb) * Photo size min 20 Kb , max 200 Kb

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Address of the Contractor

State *

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District *

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Village / Town *

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Locality *

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Nearest Landmark

Pincode *

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Post Office *

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Police Station / Outpost *

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Contractor's Birth Details

Date of Birth or age (in case of individuals)

DOB

Age

Date Of Birth

Age *

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Place of Birth

State *

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District *

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Village/Town *

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Locality *

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Nearest Landmark

Pincode *

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Post Office *

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Police Station/Outpost *

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Other Details Of The Contractor

Whether the applicant is a citizen of India: within the meaning of Article 5 of the Constitution of India. *

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Yes

No

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Whether any Criminal Case is pending at the time of making application *

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Yes

No

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Whether convicted in connection with a Criminal-Case at any time during the period of five years immediately preceding the date of application *

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Yes

No

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Whether the applicant holds a trading/business license granted by District Council *

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Yes

No

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Name of District Council granting license *

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License No *

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Date of the License *

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Valid till date *

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Tribal *

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Yes

No

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Reasons *

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Particulars of establishment where migrant workmen-are to be employed

Name of the establishment *

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Address of the establishment *

District *

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Village/Town *

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Locality *

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Nearest Landmark

Post Office *

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Police Station/Outpost *

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Pincode *

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

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Registration Number of the establishment under the Act

Date of certificate of registration

Principal Employer Details

Title

Name of the Principal Employer *

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Address of the Principal Employer

State *

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District *

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Village/Town *

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Locality *

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Nearest Landmark

Post Office *

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Police Station/Outpost *

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Pincode *

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Particulars of migrant workmen

Name, Location and Nature of work in which migrant workmen are employed or are to be employed in the establishment *

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Duration of the proposed contract work in day(Min 1 and Max 179) *

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Commencing Date *

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Ending Date *

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Name and Address of Agent/Manager

Title *

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Name of the agent or manager of the contractor at the work site *

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State *

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District *

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Village/Town *

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Locality *

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Nearest Landmark

Post Office *

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Police Station/Outpost *

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Pincode *

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Maximum number of migrant workmen proposed to be employed in the establishment on any date * Min value is 5

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Directors/Partners

Directors/Partners Details

Title

Name

Address

Title

Name

Address

Person(s) in-charge of and responsible to the company / firm

Title

Name

Address

Title

Name

Address

Other Detailsssss

State and District from where the migrant workmen were recruited

State *

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District *

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Name and address of the Agent through whom the migrant workmen were recruited *

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Whether the contractor was convicted of any offence within the proceeding five years *

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Yes

No

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Details *

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Whether there was any order against the contractor revoking or suspending license or forfeiting security deposit in respect of an earlier contract *

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Yes

No

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Order No *

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Order Date *

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Whether the contractor has worked in any other establishment within the past five years *

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Yes

No

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Establishment

Principal Employer

Nature of Work

Whether a certificate by the principal employer is enclosed. *

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Yes

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Amount of fees to be Paid(in Rs) :

Declaration

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

I Agree *

**Application once submitted cannot be modified , hence please fill up all the fields correctly.