ONLINE REGISTRATION FORM
(Required All Fields)
1. Name of Establishment( in block letters)
2. Address of Head Office( in block letters)
3. Telephone Nos. Establishment
4. Nature of Business
5. Name of Employer or M.D
6. Employees including Head Office & Contractors'
a) Earning not exceeding Rs. 10,000/- No. in Figures
b) Earning over Rs.10,000/-
7. Name of dependents of the employees for S.No. 6(a)
8. Break-up of S.No.6 (a) i)
No. of Head office Employees
ii) No. of Employees other than Head Office
a) Employed by the Establishment
b) Employed by the Contractor, if any
9. Break-up of
S.No.6 (a) according to Sex:
10. Total monthly wages paid to Employees
not exceeding Rs.10,000/- p.m.
b) Earnings over Rs.10,000/- p.m.
11. Whether registered in (Reply in Yes or No.)
ii) Shop Act
12)Establishment functioning from
NAME & DESIGNATION OF THE SENDER
WITH E-MAIL ADDRESS
SESSI I.T. Department© 2007.All Rights Reserved.