ybtJt Bgwrlrmvj ftuvtuohuNl

mhth vxuj CJl, tKtveX, ybtJt - 380001

The Bombay shops and Establishment Act 1948

NO

Vtul: 5391811

mlu 1948 BkcEle wftltu ylu mkM&tytultu yr^rlgb

The Gujarat shops and Establishment Rule 1963

mlu 1963lt sht< wftltu ylu mkM&tytult rlgb Bsc

Application Form For getting Registration Certificate

5ntuka lk. <t. - -200 &e Vele hfb Yt. JMj je^t Au. ltKt julth le mne
Statement Under Section 7(1) See Rule (5)

Registration/Renewal Form
ltuk^KeLk btKvt buJJt fhJtle yhS ltu

fjb 7 (1) nuXLk rJJhK vtf swytu rlgb (v)

lBltu yu`
(1) Name of the Establishment if any

mkM&tLk ltb ntug <tu

(2) Postal Address and situation of the Estatablishment

mkM&tLk xvtjLk mhltBk ylu M&le rJd<

(3) Situation of office, Storerom, godown, warehouse or workshop if any attached to a shop, but situated in premises different form those of the shopes.

wftl mt&u uztguj vK wftllt M&le yjdytJu je fauhe, Mxtuh Yb, dtutb JFth fu ftbLk M&ntug <tu <u M& ykdule rJd<
(4) Name of the Employer

btrjfL[k ltb
(5) Residental address of the Employer

btrjflt hnuXtKlt M&Lk mhltBk.

(6) Name of the manager if any, and his residential address

u ntug <tu gJM&tvfLk ltb ylu <ult hnuXtKl M&Lk mhltBk

(7) Category of the establishment i.e.whether a shop,Commercial Establishment, Residental Hotel, Resturant,Eatinghouse Theatre or Entertainment

mkM&tle fth yuxju fu wftl, gtvthe mkM&t hnuJtle mdJz ^htJ<e ntuxj, huMxtuhuLx, Ctusltjg, r&yuxh fu ytlk btu y&Jt bltuhksl btxuLk ceswk ftuE nuh M& Au fu
(8) Nature of Business

ftbftsltu fth
(9) Date of commencement of Business

ftbfts NY fgot <theF

(10)

Name of the members of Employers family employed in the Establishment mkM&tlt btjeflt su fwxwkcesltulu mkM&tbtk ltufheyu htFJtbtk ytgt ntug <ublt ltbtu. Men / Yttu

Adults Jglt Nmtu

Young person ltle Jg lt mmtu

Total fwj

Women / Mteytu Total fwj (11) Name of the other persons occupying position of Employee engaged in confidaential capacity (indicate sex and age in case of young person) gJM&t<ktbtk ntu]tu ^htJ<e yLg grf<ytu y&Jt rJtmvtt grf<ytu <hefu ltufhebtk hFtguj grf<ytult ltbtu (ltle grf<ytule ctc<btk r< ylu Jg sKtJJt ) Total namber of Employees ltufhegt<tule fwj mkgt

(12)

Adults Jglt Nmtu

Young person ltle Jg lt mmtu

Total fwj

Men / Yttu

Women / Mteytu Total fwj Dated Dated 200 200 Signature of Employer (btrjfle mne)

Notes (1) (2) (3)

This statment should be sent to the inspector of local area concerned with such fees are prescribed in schedule. Item 3 should be filled only when office, storeroom etc. is not separately registered under the Act in respect of such office storeroom etc., particulars required under item 10,11 and 12 should be given separately in this statment. If the numbers of Employer is more then one the names and Residential address of Employers shll be given in item 4 and 5 respectively.

ltuk^ : ( 1) yLmra 1 btk NotJuj Ve mt&u jtd<tJd<t M&trlf rJM<thlt lehtf lu rJJhK vt btufjk
( h ) fauhe Mxtuh- Yb rJduhu yr^rlgb nuX yjd ltuk^Ke l fhtJe ntug gthu s ctc< 3 ChJe, ytJe fauheytu Mxtuh Yb Jduhule ctc< ykdu 10,11 ylu 12 nuX ytvJe stuE<e rJd<tu yt rJJhK vtfbtk yjd ytvJe ( 3) btrjfele mkgt yuf&e J^thu ntug <u c^t btrjftult ltb ylu mhltbtk yLbu 4 ylu 5btk ytvJt