Application for Certificate of Establishment

Under The Sikkim Shops & Commercial Establishment Act 1983

Labour Department, Government of Sikkim

Applying To: Labour Department

Office situated at: *

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Kindly select if you are Applying for a NEW REGISTRATION OR if you have been ALREADY REGISTERED

Registration Status *

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2. Applicant Details

Full Name of Applicant *

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E-Mail of Applicant *

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Applicant's Photograph *

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1. Name of the Establishment *

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2. Full postal address and location of the Establishment *

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3. Situation of Office, storeroom, Godown, warehouse or workplace. If any attached to the establishment but situated in the premises different from those of the Establishment *

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4. Category of Establishment: *

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5. Particulars of the person having interest in the Establishment as Employer (applicable only where a nomination is made under Section 76)

Name Parentage

Designation

Permanent Address

Nature of interest: (Whether Partnership Member, Director Shareholders)

Name Parentage

Designation

Permanent Address

Nature of interest: (Whether Partnership Member, Director Shareholders)

6. Nature of Business (Description) *

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7. Name, Designation and Permanent Address of the Employer (Manager, Agent or any other person) who is immediate Incharge of the General Management or Control of the Establishment

Full Name of Employer

Designation of Employer

Permanent Address

Full Name of Employer

Designation of Employer

Permanent Address

8. Particulars of the members of the Employer's family employed in the Establishments as defined in Section 2(17)

Full Name

Age

Sex

Relationship with the Employer

Full Name

Age

Sex

Relationship with the Employer

9. Name of the other person occupying the position of the Management or Employees engaged confidential capacity, if any

Full Name

Age

Sex

Relationship with the Employer

Full Name

Age

Sex

Relationship with the Employer

10. Total Number of Employees *

Adult (18 years and Above) *

Male *

Female *

Total *

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Total Number of Employees *

Young Person (14 to 17 years of Age) *

Male *

Female *

Total *

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11. Name of the day of the week on which weekly holidays will be observed; as per relevant Notification (in case of Shop and Commercial Establishments only)

Declaration

I hereby solemnly affirm and declare that to the best of my knowledge and belief :

I am a citizen of India.
I have not concealed or suppressed any information, the disclosure of which would make me disentitled for this Certificate.
I shall be held responsible for any misrepresentation or false information given by me while applying for this Certificate.

I Agree *