Official gaz / gover,nment of goa, daman and



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21.S3J\:AUGU8T?~1980 (SRAVANA 30~ 1905)

No. and date

No. and date of crossed de­of the crossed

mand·draftof

demand draft· of Afu.o~nt 1>1 Amount of the ba,laIicesecurity depo!lit pre;vious secu­security deposit security deposit

in ~sPeCt of rity deposit , . fo~ tiliefresh '

depoSited with the~previous the fresh appli­

licence

): 'jIid!nCe

: . cation "'; ~" •..:,;<.',

6 J 8

\(-~": ;,' :;;;~ G:·,~:'::~'<~l N&.a·and da.t~

~";J:, :~, .~>r·)·

i /; '.~:~_rJ:·:)'ir r~tratioli. of. Name ;md

of certificate of

the l!stablishmeJ'rt address of the Particulars of 1.

in .relation to principal em­fresh appli­Remarlts which the fresh ployer Cation

licence is '!-pplied for

9 , 10 12

'i';;'" I.' L0'i':..

!J, I \. ~

PI~: ( Sigp.ature of applicant Date:

F0RM VIII

\. [See \rul~ '11(1)]'

".... G6Vi:RNMENr OF INDIA

:,',

Office of Licensing Officer

(il'

(.L bJ..· :.. '

Licence lIT(). . .. Dated ... Fee paid Rs.

LICENCE

Licence is .hereby granted to .., un4er section 8~(i) of the :rnte-.r"'State ~grant,:Wor1pnan (Regulationiof Employment and Conditions )j~£: ,8ervice) ACt; 1979, 'subject MCTh¢coon­mtions specified in the Annexure. ",n ..

Ii':' ,. : :. .• . ',i'

2.,!I'his licence' is for doing the work of (nature of" work to be indicated) in the establishment of (name of principal emP,19Yerto.ge indicated) at(I>~~~e. of work to be indicated).

3. The licence shall remain.info:rce till (date to be indi­

ca~e4).

Signat)l~~:#~ Sel;lrof Licensing Officer

: RENEWAL

[Seerul~14j

Date of renewal Fee paid for renewal Date of expiry

0:1' ri.






3:

Date Signature ,and Seal. of the Licensing Officer

ANNEXURE

The licence is subject to the .following conditions:­

1. The licence shall be nori!triuisferabl~;'

:i ."'2:" ·The number of workmen employed as migrant work­'meri ifi the establishment shall not, on any day, 'exceed the maximumtl~ber specified in the appli­

cation for licence. . . .." .

;;:;);~ave;aspro'V~dedin' fllese'rules the" ~eespaid\ for tIfe'griwt':or aStlie;cas~maybe: if6r"rimewal,,·ofliceila;J'$lifiun~bE!:)ru,ri"'reiftin(bi1!ile~ i',,};,"',i': ..,;' .I,.

4 •. The rate/:! ()fyv. ag.e.s Fayab~~.t.O

by the contractor s~alL nott prescribed under l:he.Minimum such ..erhploymentw::!1eteappH ..' rates have.been fixed. by. agreement,award; :hot less than the~ raites,'sGfixecL .

.. 5.' (a:) incases'where th~ migrant ~W6rRm.enerilplaYed by the contractor perform the same:jjlt;:$imil!U' kind of work l:tsthe ~orkIll~n.9irec.tly:, IOled . 'by the Principa:lEinployer <:ffthee'Sft1: i'lnt, the wage rates, holidays, hours of and other conditions Q,f,..../:!e.rvice o,f . migrant worJ,qnen of. the cQlirta:q~o.t; sha~; th ,;,.~ as applicable to the workmen yed by the Principal Employer o~.the ent on the same !.of or simUar kind

C:,:',: .'

Provided that in the case of any disagreem!Ont with regard to the type of wO:rk, the salne shall be decided by tlie Deputy Chief L~bour Commissioner (Central)

~hose dE1cision ,~~~11 be .. final. J •

y; .(b) ln o~er. cases th,e'~E;e r1i~~~, hol.. i.da.vs. of work and cond~tiol;ls.of ..servrc!:. '1f mitlt!!'ll.nlt workmen of the: contractor shaJl ;'e as

(;' prescribed (in the~e rules.

6. Every migrant workman shall be entitled allo'\i,.­ance, benefits, facilities, etc., as prescribed in the Act and these Rules.

by

J. ,No female migrant WOrltman shall be

. ·,ariYcontl'actOI'·,before 6 a:J.11.' or after

Provided that this clause shall not apply to the employ­ment:of female migrant workman in Pit head Baths, Creches and Canteens and as Midwives and Nurses in hospitals and dispensaries.

8. The contractor shall notify any change in the number

of migrant workmen or the conditions of to . the licensillg officel,'.·

t

9. The contr~ctor shall co~plY with all the provIsions ·of the Act and, these Rules.

\'.-;.. ,

10. A copy of the licence shall be displllyed prominently at tll.e premises where the migrant workmen are empioyed.

FORM IX

1\

[See rule 15(2)] "

.',: . Applicatio.p, for R~ewal of .Licrn~

  1. Name andacldress of the contractor.

  2. Number and date of the licence.

  3. Date of expiry of the previous licence.


4. Wh~ther the licence of thecontractQ~ was suspended

or revoked. ' . . '. .

5. Number and date of the crOSsed dem'ant1 draft erielol;ed.

Place ... Signature of the Applicant

Date ..•.

(To be filled in the Office of the Licensing Officer)

Date of receipt of the application with crossed demand draft No. and date.

Signature of the Licensing Officer

FOIU\f X

[See rule .21)

[Form in which to furnish particulars in respect of

recl'1Ji,t;IIl~ntlll1d eIIlployment 0:( migrant workman/workmen".M.' pres<;r~pe~, tlM~r'sub-rule(l) pf Rule 21,' to tll~ autliori­, tie8~pecifiedtfuder the. explanation below I:\ub·section' (2)of secti~h ,.l;~; qftnter~'State MigT!tnt w~rknien(Regulatidn of Employment'iandConditi6nscif Services) Act, 1979])':

1. Name and 'address' of tlie Contractor ;" ,."

BERIES 1 No. 21

"::2~."~aJne Sfdaddress of the sub"cQntractor th~ough'whom .. ~ recruitment has been made '" . .

. ·S•. Name~d apdress of the establishment •..

4. Name.8.ndaddress .of the !"rincipalEmployer, ~. Name"of.. :the State in which the, place of· ,work is

located... . .

6. Name .of the State in which recruitment was made

Name of Father'sl

Permanent

.:;11. No. Dligrant Husband's Sex Age

.home address

workirian .name

'2 3 4 5 G

Name and Place and

address of the ~.A.tnount of AIDount of next of kln'.of displacement outward journey

address of ~i­,~~Iii'the

themi~t allowance paid allowance paid

/ home State

workiri~>'

  1. Name and address of the sub"-contractor thlWU[l;h recruitment has been made ., .

  2. Name and address of the establishment, :4. Name ~({ad.dress; (If the prfuCipal Em~ioyer




  1. Name of the State in which the place of located ...

  2. Name of the state in which recruitment was mad~) ..


Name of Father'sl SI. No. migrant Husban(J.'s Designationworkirien name

1 2 3 5

,-="'=-""''''''''''''''''''

Place and

Perma.:IlIlnt Date on

address of

home address Date of which

residence

Indicating Employment ceased to

In home

the State be employed

State

c'r

8 9 10

./,

/'~'

Amount of

"wages fc:irQu~, Nature of job Date of Date of ward journey recruitment employment

.' required to.be period paid'

performed

U 12 13 14

,,Detalls of rates of wages and Details of

Period of

contract of

other allowances other service 'Remarks

employment

p?,yable, conditions

16 17 18

Signature of Contractqr or his authorised 'representative

Date ... SUbmitted to

(1)

(Specified authority in the State' in which migrant workman/workmen is/are employed).

(2)

(Specified authority in the State from, . which the migrant workman/workmen has/have been recruited)

Copy fOtylarded to (The Principal Employer)

) Signature of the: Contractor or his authorised repx:esen­tative.

Date ...

Note: In case where migrant workmen concerned havebOOn recrUi'tea' from more than one States, separate returns shall be submitted in respect of each such State.

FORM XI

[See rule 24]

[Return', to be sent by the Contractor to the authorities .speeifjed~der explanation belqw sub-section: (2).9f sec­.non 12 of Inter-.~tate MigrantWorlmlen (R;egulation of

Employment anddonditions ·of Servtce).Act, 1~79] .

1. Name and address of the contractor

--~"-"~'"'.-,,~

7 8 9 10

__'_'"''''''''''_'''''ffi'''''-'''

Amount of Amount of Details of outward return rate of journey journey

Amount of displacement

wages and allowances allowance

allowance

other allow-and wages and wages

paid

ances paid for outward for return journey paid journey paid

12 13 14 15 li

. Details 01; Amount ofcompensa-Amount of Amount of advance, if

tion and deductions, adv~ce, if Remarks

any

reco~

other allow-if ~y any paid ances

vered 17 18 19 20 211

----.--

DECLARATION

I/we hereby declare that all wages, other dues including displacement allowance, outward return journeys allowances and wages for journeys periods payable to migrant workman/ /workmen names above and employed by me/us have been paid by me/us/to him/them.

Place

.. .

Signature of the Contractor or his

Date

.. .

authorised representative

.Submitted f.o



(1)


(SpeCified authority in the State in which migrant workman/workmen is/are employed)

(Specified authority in the State from which the migrant workman/workmen has/have been recruited).

Copy forwarded to

(The PrinCipal Employer)

Signature of the Contractor or his authorised representative

Date ...

Note: In 'cas(l where migrant workmen concerned have . been recruited froin more than one Stat(l, seJ;larate returns shall be submitted lprespect of eachsuchSt~te:; .

21ST AUGUST, 1980 (SRAVANA 30, 1902)

...-~-.-.----~

Name and address of Month andFORM XiI the Principal

[See rule 48] Employer ... Register of Oontractors

Permanent home

Name of the mi­Father's/Hus­address indicating

(1) Name and address of the Principal Employer S1. No,

grant workman band's name the State

(2) N:ame and address of the establishment .,.

Period of con-Maximum No. Name and Nature of Location of tract of migrant

address of· work on

contract workmen·­work employed by

contractor contract from to contractor

-----------......,---------~~.--.-­

5 6 7

FORM XIII Railway sta~

Place of work tion/bus standPlace of re. with address

[See Rule 49] nearest to the

cruitment indicating the place of

Register of Workmen Employed by Contractor State residence

Name and address of Name and address of 9 10 11 Contractor ... establishment in/under which migrant work­

Name and address of

·men are employed .. ,

the establishment Name and address of

Details of Principal Employer ... modes of jour­

Date and time Expected date neys from the of commence. and time of place of resi. Permanent ment of journey arrival at the dence in the HOffie from the place place of worlr home State to Name and Address of residence the place

Father's/ Nature of

SUl'Hame of Age and of migrant of work

Sl. No. Husband's employment/

rr' \~ant sex workmen

I name designation

-workman (village and -----------_._----_._­

.--.~.-.­

Tehsil/Taluk 13 14 15 and District)

1 2 3 4 5 6

------------,-------~-,~--

Total of Amount of dis­

amounts indica-placement allo-Amount of.

ted in column wance outward jo'urneyDate of Signature

or thumb-Date or no. 16 Rs. Ps. allowance

commence­

Local ment of -impression termination Reasons for Remarks -----------------------------_.----.

Address eItJ.ploy_ of migrant of employ-termination 17 18 19 20 ment workman ment ----------..

7 8 9 10 11 12

Signature or Actual date Total Amount Date .on which thumb impres-and time of paid paid sion of the mi_ arrival at the grant workman place of work

Signature of Contractor or his authorised representative 21 22 23 24

FORM XIV Balance wages Date of payment Signature or for outward of the balance thumb impres­

[See Rule 50]

journey if any, wages indicated sion of the mig-Remarks payable in Col. No. 25 rant workman

Service Certificate

------~------.

25 26 27 28

Name and address of Name and address of Contractor ... establishment in/under Nature ahd location of which migrant work­

work : .. men are emplQyed ...

Note: Indicate separately different mode of journeys.

Name and address of

Name and address of the Entries are to be made against each individual migrant

migrant workman .. . Principal Employer ..,

workman. Age 9r Date of Birth....

Signature of the Contractor or his authorisedIdentification Marks ...

Representative

Father's/Husband's name ." Date ... Rate of

Total period for wages (with

which employed_ particulars)

S1. No. _______ Nature of

Remarkswork done of unit in

FORM XVI

From To case of piece-work

[See rule 51(1)] 1 2 3 4 5

Return Journey Allowance Register

Signature of Contraotor or his Name and Address of the Name and Address of the authorised representative Contractor Establishment ...

Name & address of the Month and Year ... Principal Employer ... FORM XV

[See Rule 51(1)] Place & address

Name of Father's/ Permanent home of residence DiSPlacement and outward Journe/'"allowa:nces sheet SI. No. the migrant Husband's address indica-in the home

workman name Hng the State State Narrieand address of ./!,~e and address of the

1 2 3 4 5

the Contractor ." establishment ... .

200.

Railway St&­tion/bus standDesignation Rate of wages Place of work

nearest to the place of wo'rk

6 7 8 9

:,'

Railway sta­Hon/bus sta.nd ne,arestc to the place of resi­dence in the ,home State

Date and time of'commence­ment of journeyfrom the placeof work

Expected date and time of arrival at the residence in home State

Expected modes of journeys·from the place of work to place of,resi­dence in the home State

w.___________ __






10


11 12 13·

Amounts of bus

fare and/or

-.-seeond·-class.,'-,

train fare andl

or other jour~

"

Total amounts Amount of Wages for re­'separate(yas

ney .expenses,

indicated in return journey turn journey per expected

column No, 14 allowance period modes of jour­'n'eyS indicated'

in column

No. 13

l' 15 16 17







Signature or










thumb lmpres­




Total amount

Date on which

sion of the

Remarks

. paid .

. paid

migrant










workman



18. 19 ~o 21



I,.

,$ Indicate separately differtmt modes of journey.

". Note: Entries are to be made against each individual inter~Statemigrant workman.

Signature of the Controller or his authorised Representa­tive

Date ...

FORM XVII

[See rule 52(2) (a)] Muster Roll

Name and Address of Con­Name and Address of Esta­tractor ... blishment in/under which migrant workmen are em­

N:!liture',' a,nd Location of

ployed... '

work Name and Address of Prin­cipal Employer ...

For the month of

Name'of Dates

Father's/Hus-Sex

S1. No. migrant -----'---Remarks

band's name

wor~~n 1 2 345

FORM XVIII {See rule 52 (2) (a)] R~gister of 'Wages

N.ame and Address of Con­Name and Add'ress of Esta­tractor .., blishment in/under which

.... _.._-----.--~----

Nature and Location of work inter·State: men are Name and A.ddress cipal Employer Wage period .,'

Serial No. in the

Sl Name of inter-State

register of

. No. migrant wOJ;kman

workmen

1 2 3
Amount

Daily.rate of

No. of days Units of work

wages/piece­

worked done Basic­

ra.te

5
wages earned

-----------------.-...

Other cash pa.y­ments (Nature Dearness allo-Overtime of payment to

wance be :indicated)

9 10 11

Deductions, if any (indicate nature)

Net amount paid

workman

13

14

15

16

FORM XIX [See rule 52(2) (c)] Register of Deductions for Damage or Los!!; Name and Address of Con­Name and Address of Esta..



tractor ... blishment in/under which inter-State migr&"lt work­

Nature and Location of work men are employed. .,_

Name and Adress of Prin.. cipal Employer ._,

--".-....,.,.....,.,.....,,-=,..

81. No.

Name of inter­-State migrantworkman

Father's/Hus­band's name

Designation/ /Nature of employment

Particulars of damage or loss













-------.

1

2

3

4

5

Whether inter-Name of person-State migrant in whose pre-Amount of de­Date of damage workman showed sence employee's duction im­



or loss causes against explanation posed deduction V;'aB heard

6 7 8

Date of recovery

Remarks

No. of instal­

ments First instalment Last instalment

12 13

10 11

FORM XX [See rule 52(2) (c) Register of Fines

Name and Address of Name and Address of Esta­ContractOl' ... blishment in/under which inter-State migrant work­

Nature and location of work _.,

men are employed .. _

Name and Address of Principal Employer .. _

Sl N Na:ne of inter-Stare' Father's/Hus-Designation/Nature

• O. mIgrant workman 're_"".-b_a_n_d_'s_n_a_m_e____o_f_e_m_p_l_O_y_m'-en_t__

1 2 ...., B

218P AUGU8T~ 1980 (SRAVANA 30, 1902)

------------._----------_•._-----

Whether inter­Name of person Act/Omission _State mig-rant in whose pre­fo-rwhich .fine Date of ofl'ence wodonan sence employee's

. ~Inposed showed cause e",planation against fme was heard

7 6 7 8

Wage periods

Amount of fine· Date of which

andw!iges Remarks

imposed fine Irealised

Payable

9 10 11 12

FORM XXI [See rule 52.(2) (c)] Register of Advances

Name and' Address'of .' Name and Address of Esta­Contractor ... blishment in/under which inter-State migrant work­

Nature and locatioo of work ...

men are employed ... Name and Address of Principal Employer ...

Nature of Wage pe_ Date and

Name of iinter-Father's/Hus-employ-riod and amount of

81. No. -State migrant band's name ment/De-wages pa-advance workman signation yable given

,

1 2 3 4 5

No. of ins­

Purpose(s) Date and Date on

talments by

fOT which amount of which last

which ad-Remark!!

advance each instal-instwlment

v3.l1ce to be

made ment repaid was repaid

repaid 7 8 9 10 11

FORM XXII [See rule 52(2)(d) j Register of Overtime

Name_ and Address of Name and Address of Esta­Contractor ... blishment in/under which Nature and locatioo of work .. , migrant .workmen are

employed ...

Name and Address of Principal Jl!mployer ...

Name-of inter-Designa-

Father's/HU8-tion/Nature workman

81. No. -State mig-rant Sex,

band's name of employ­ment

1 2 3 4 5

Date on whiCh Total overtime worked. or pro-Normwl rates overtime worked duction in case of piece-rated of wages

7 8

6 J

~-------------------------------------------

Overtime rate of wages

Overtime earnings

,{;

Date on which overtime wagespaid

Remark.

-----------------------~







9

10

11

12

FORM XXIII [See rule 56(1)] Return to be sent by the Contractor to Licemri.ng OlficeI



Half-Year Ending ........... L Name and address of the Contractor:

2. Name and address of the establishment. 3, Name and address of the Principal Employer' 4, Duration of contract: From .,. to

5. No. of days during the half year on which

(a) the establishment of the principal had worked ...

(b) the contractors' establishment had

  1. Maximum number of i-!Jlter-State migrant employed on any daycluring the half-year: Men . Women Children Total

  2. (i) Daily hours of work and spread over.


(ti) (a) whether weekly holiday observed day:

(b) if so, whether it was paid for:

(iii) No. of man-hours of overtime worked:

  1. Number of mandays worked by: Men Women Children Total

  2. Amount of wages paid: Men Women Children Total


Note: -Wages shall not include wages for outwards and return journeys.

10. Amount of deductions from wages, if any: Men Women Children Total

11. Amount of displacement allowance paid: Men Women Children Total

12. Amount of Outward journey allowance paid: Men Women Children Total
13, Amount of wages for outward journeys period paid; Men Women Children Total

14. Amount of return journeys allowance paid: Men Women Children Total

15. Amount of wages for return journeys period paid: Men Women Children Total

16. Whether the following have been provided:
(i) Residential accommodation;

(ii) Protective clothing;
(iii) Canteen;

(iv) Rest-room;

(v) Latrine and Urinals;

(vi) Drinking water;
(vii) Creche;

(viii) Medical facilities; (!x) First Aid.

(If the answer is "yes' state briefly nature/standards pro­vided). Place .. . Signature of Contractor

Date .. .

FORM XXIV [See Rule 56(2)] AnmJal Return of Principal Employer to be lient to the Registering Officer

Year ending 31st December 1, Full name and address of the Principal Employer: 2, Name of the establishment:

(a.) District:

I

202

(b) Postal Address:

(c) Nature of operation/industry/work carried on:


  1. Full name of the .Manager or person responsible for supervision and control of the establishment.

  2. Number, of contractors who worked in the establish­ment duririg'the year (Give details in AIIDexure) ,

  3. Nature of work/operations on which Migrant workman was employed.

  4. Total'iullnber' of days during the year on which migrant workman was employed.


7~ Total number of mandays worked for by migrant work· man duriD.g the'year.

  1. 'MaximUm number of workmen employed directly on any day duringthe year.

  2. Total num~r of days during the year on which direct labour was eIllploye4.

  3. Total number of mandays worked by directly employed workmen.. '

  4. Change, if any, in the management of the establish­ment, its location, or any other particulars furnished to the


Registering Officer in the appHcation for Registration cating also the dates.

Pilice ... Date ",

ANNEXPRE TO FORM

Period of contract

Name and Address

Natureof the contractor To

From

-----:-1--------2-------'---·,--'-'---'

4 .5

[No, S. 16027/10;

R. KUNJITHAPADAM,

_'.r:·'''·

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