APPLICATION FOR REGISTRATION OR RENEWAL OF REGISTRATION OF AN ESTABLISHMENT.

1.                     Name of the employer.

2.                     Full postal address of the employer.

3.                     The name, if any, of the establishment.

4.                     Full postal address of the establishment.

5.                     The category of the establishment.

6.                     The date of which the establishment commenced work.

7.                     No. employee/employees employed on the date of

Application.

8.                     In case of renewal of registration whether the

Registration certificate of the previous year enclosed.

9.                     An amount of Rs.______(Rupees.__________)ob\only has been paid_______ Treasury ____

On_____ under the head of account _______(vide challis No._____ date.__________
(enclosed)

Date._________                               Signature of the employer.

State if it is a shop, an establishment, residential hotel, Non-residential hotel, resturant, boarding or eating house, theatre or other place of public amusement or entertainment.

                 Received an application in Form No.1 with treasury challis No._____ dated______from _________this day of_______

                                                                

                                                                Signature of the Inspector, shops

                                                         and commercial Establishment, Ganjam.

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