1.
Name of Establishment(Department Name) *:
2.
State :
District*:
Tehsil* :
Village* :
Plot No./Milestone/Village/Street :
Colony/Sector/Road/Post Office* :
3.
Pincode* :
4.
Phone :
5.
Mobile No* :
6.
Fax :
7.
Date of Commencement *:
8.
Email * :
9.
Password* :
10.
Confirm Password* :
(The Email Id and Password entered above will be used for logging into the site at home page)
Details of Principal Employer
12.
Aadhaar Number * :
13.
Father's Name*:
14.
Plot No./Milestone/Village/Street :
City/Sector/Road/Post Office :
State :
District*:
Tehsil* :
Village* :
15.
Pincode :
16.
Phone No (with STD Code) :
17.
Mobile No* :
18.
Fax :
19.
Email* :
20.
Nature of work of Principal Employer:
21.
Circle of Concerned Labour Inspector in which the Unit is located* :
