FORMS UNDER APSE ACT

Government of Andhra Pradesh

LABOUR DEPARTMENT

Application for Registration FORM - I

Of Establishment under

Section (1) & Rule (3)

Vide Rule 3 A.P.Shops & Establishment Rule 1990

------------------------------------------------------------------------------------------------

1. Classification of Establishment 1. Proprietory Firm

2. Partnership Firm

3. Private Limited Company

4. Public Ltd., Company.

------------------------------------------------------------------------------------------------

2. Category of Establishment 1. Shop

2. mercial Establishment

3. Hotel, Restaurants Catering House Lodging and Café

4. Public Ltd., Company.

------------------------------------------------------------------------------------------------

3. Name of Establishment _________________________________

_________________________________

------------------------------------------------------------------------------------------------

4. Address : Door No.______________________________

Locality _______________________________

Village/Town __________________________

District ________________________________

Pin Code

------------------------------------------------------------------------------------------------

5. Location of Office, Godown, Ware- Door No. Locality

house or Work Place attached to 1.______________ _______________

the Shop/Establishment but 2.______________ _______________

situated outside the premises of it. 3.______________ _______________

------------------------------------------------------------------------------------------------

6.Employer/Managing Partner/ Name : ___________________________

Managing Director as the Father’s Name _____________________

case may be Designation _______________________

------------------------------------------------------------------------------------------------

7. Residential address of the Door No. ______________________________

employer Locality _______________________________

Village / Town _________________________

------------------------------------------------------------------------------------------------

8. Manager/Agent if any with Name _________________________________

residential address Father’s Name __________________________

Designation ____________________________

Door No. ______________________________

Locality _______________________________

Village / Town. _________________________

------------------------------------------------------------------------------------------------

9. Nature of Business :

------------------------------------------------------------------------------------------------

10. Date of Commencement Date Month Year

of business :

------------------------------------------------------------------------------------------------

11.Name of family member of employees family engaged in Shop/Establishment

------------------------------------------------------------------------------------------------

Relationship Adults Young Persons

------------------------------------------------------------------------------------------------

Male :

Female :

------------------------------------------------------------------------------------------------

Total

------------------------------------------------------------------------------------------------

12. Total No.of Employees Adults Young persons

Male

Female

Total

------------------------------------------------------------------------------------------------

13. Name of Employees :

------------------------------------------------------------------------------------------------

In a Managerial Capacity | As Sweeper caretaker| As persons employed | Others

| & Travelling Staff | loading & unloading |

| | of goods at godowns |

------------------------------------------------------------------------------------------------

1. 2. 3. 4.

------------------------------------------------------------------------------------------------

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

------------------------------------------------------------------------------------------------

14. Details of remittances of the fees :

------------------------------------------------------------------------------------------------

Name of the Treasury | Challan No. | Date | Amount of fee paid

------------------------------------------------------------------------------------------------

1. 2. 3. 4.

------------------------------------------------------------------------------------------------

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

------------------------------------------------------------------------------------------------

I declare that the above information is true to the best of my knowledge & belief

------------------------------------------------------------------------------------------------

Signature of the Employer

Note : This statement shall be submitted to the Inspector of the concerned area accompained by challan in support of payment of fees as Prescribed Schedule 1.

Government of Andhra Pradesh

Labour Department

FORM – III

(See Rule 3 (4) )

APPLICATION FOR RENEWAL

1. Name of the Shop/Establishment :

and address

2. Previous Registration Certificate :

No. & Date

3. Year for which renewal is required

along with

(i) Challan No. with date

(ii) Amount paid through the challan

4. Full Name of the Employer including

Father’s name

5. Full Name of the Manager including

Father’s Name

6. Change in the name of the Partners

if any

7. Change in the postal address and door

No. if any of Shop / Establishment

8. Total number of Employees :

I hereby declare that the above information is true to the best of my knowledge and belief.

Signature of the employer / Manager

FORM E – NOTICE OF CHARGE

(Vide Rule 7 of A.P.Shops & Establishment Rule – 1968)

Name of the Establishment already registered _________________________

Name of the Employer _________________________________________________

Registration Certificate Number _________________________________________

Address ____________________________________________________________

Dated the __________________________ day of ___________________ 200

To

The Inspector

__________________________________________________________________

(Under the Andhra Pradesh Shops and Establishment Act 1966) Notice is hereby given that the following change has taken place in respect of information forwarded to you in Form ‘I’ which please note.

The Registration Certificate and Challan No. ______________________

Dated __________________ for Rs. __________________________________

Are herewith enclosed.

Signature of Employer

NOTE : The notice of change in this form shall be sent together with such fees as are prescribed in schedule II.