Place*

Name of the Principal Employer *

Name of the establishment *

Address of the Principal Employer *

Postal Address of the Establishment *

Name of the Director/Partner

Name of Manager *

Address of Manager *

Name of work carried on in the establishment *

	Contractor Name *	Contractor Address *	Nature of Work *	Date of commencement of work *	Date of termination *	Mobile Phone*

No of Migrant Workman *

Email*

No of Male Employees *

Mobile Number *

No. of Female Employees

Upload supporting documents (ID proof principal employer/Company registration details/Building permit) *(pdf only)

*Mandatory fields