Haryana Labour :: Index

Apply for becoming beneficiary of Silicosis

Fields marked * are mandatory.

1. Name of Applicant (आवेदक का नाम): *

(Please use the same name as on Aadhaar Card and do not use Sh./Mr. etc with your name if it is not on aadhaar card.)

2. Father’s / Husband Name (पिता / पति का नाम): *

3. Aadhaar No. (आधार संख्या): *

4. Aadhaar File (आधार छवि): *

Only jpeg, png, jpg, pdf format allowed maximum upload file size 2MB

5. Permanent Address (स्थायी पता): *

6. Current Address (वर्तमान पता): *

7. Mobile No (मोबाइल नंबर): *

8. Bank Details (बैंक विवरण): *

a). A/C No : b). IFSC Code : c). Name & Branch :

9. Date of Birth (जन्म की तारीख): *

10. Gender (लिंग): *

Male (पुरुष) Female (महिला) Other (ट्रांसजेंडर)

11. Applicant Photo (आवेदक फोटो): *

Only jpeg, png, jpg format allowed maximum upload file size 2MB

12. Medical Report (चिकत्सा रिपोर्ट): *

X-Ray (एक्स-रे): *

Only jpeg, png, jpg, pdf format allowed maximum upload file size 3MB

CT Scan (सीटी स्कैन): *

Only jpeg, png, jpg, pdf format allowed maximum upload file size 3MB

Medical Prescription (चिकित्सा प्रवण): *

Only jpeg, png, jpg, pdf format allowed maximum upload file size 3MB

Any Other (कोई दूसरा):

Only jpeg, png, jpg, pdf format allowed maximum upload file size 3MB

13. General Document (सामान्य दस्तावेज):

ESI Card (ईएसआई कार्ड): *

Only jpeg, png, jpg, pdf format allowed maximum upload file size 3MB

Any Other (कोई दूसरा):

Only jpeg, png, jpg, pdf format allowed maximum upload file size 3MB

14. How you come to know you are suffering from Silicosis?
(आपको कैसे पता चलेगा कि आप सिलिकोसिस से पीड़ित हैं?) : *

15. Email (ईमेल):

16. Choose Password (पासवर्ड चुनें): *

Password must be between 6 to 12 in length

17. Confirm Password (पासवर्ड की पुष्टि कीजिये): *

Password must be between 6 to 12 in length

Add Work Experience (कार्य अनुभव जोड़ें)

Experience 1 *

Name of Factory / Construction Site
(कारखाने / निर्माण स्थल का नाम)

Employer Name (नियोक्ता का नाम)

District (ज़िला)

Tehsil (तहसील)

Village (गांव)

Address (पता)

Start Date

End Date

Upload Work Experience
(कार्य अनुभव अपलोड करें) Please Upload a jpeg, png, jpg file max 2MB size only

Experience 2

Name of Factory / Construction Site
(कारखाने / निर्माण स्थल का नाम)

Employer Name (नियोक्ता का नाम)

District (ज़िला)

Tehsil (तहसील)

Village (गांव)

Address (पता)

Start Date

End Date

Upload Work Experience
(कार्य अनुभव अपलोड करें) Please Upload a jpeg, png, jpg file max 2MB size only

Experience 3

Name of Factory / Construction Site
(कारखाने / निर्माण स्थल का नाम)

Employer Name (नियोक्ता का नाम)

District (ज़िला)

Tehsil (तहसील)

Village (गांव)

Address (पता)

Start Date

End Date

Upload Work Experience
(कार्य अनुभव अपलोड करें) Please Upload a jpeg, png, jpg file max 2MB size only

DECLARATION :-

स्वघोषित हल्फनामा किसी भी प्रकार से श्रमिक की कार्य विवरणी के रूप में साक्ष्य नहीं माना जाएगा |

I do hereby declare that the statement given above is true and correct to the best of my knowlege. In case any information is found to be concealed, my registration number may be cancelled and I shall be liable for furnishing false information.

Head Office

Labour Department,Haryana
30 Bays Building, Sector 17,
Chandigarh - 160 017

Haryana Labour Welfare Board and HBOCW Board
Bays No. 29-30 (Pocket-II)
Sector-4, Panchkula - 134 112

CONTACT US

Phone No.

Head Office : 0172-2701373

ALC NCR : 0124-2301138

Shramik Helpline Number : 0172-2971057

Toll Free : 1800-180-2129
(Shramik Sahayata Sewa, 8am to 8pm - Monday to Saturday)

Haryana Labour Welfare Board :

Landline : 0172-2560015

HBOCWW Board :

Landline : 0172-2575300

Toll Free : 1800-180-4818 (Only for managements)

SARAL Helpline: 0172-3968400

Website : https://saralharyana.gov.in

Email

For Non Technical Support : labourcommissioner∂hry.nic.in

For Technical Support :

Labour Department : mailitcelllabour∂gmail.com

HLWB : hlwbgrievance∂gmail.com

HBOCWWB : hbocwwb∂gmail.com

All rights reserved - Labour Department, Haryana