Section 109 in Employees' State Insurance (General) Regulations, 1950

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Union of India - Section

Section 109 in Employees' State Insurance (General) Regulations, 1950

109. [ Submission of additional information by employer or insured person.- [ Added by Noti. Noti. No. N-12/13/2/92-P&D, dated 22.4.1994 (w.e.f. 1.4.1994).]

The employer or insured person, as the case may be, shall, on demand from the appropriate Office, submit information in such form as may be specified by the Director-General.]FORM 01EMPLOYERS'REGISTRATION FORM[Regulation 10-B]

*Employer's Code No.		{\|

|-|||||-| 1.| Name of the Factory/Establishment| :| .............................................................|-| 2.| Complete postal address of the Factory/Establishment| :| .............................................................|-| 3.| (a) Telephone No., If any| :| .............................................................|-|| (b) Fax No., if any| :| .............................................................|-|| (c) E-mail address, if any| :| .............................................................|-|| (d) name of Town/Revenue Village| :| ...........................(Taluk/Tehsil)..........|-|| (e) Police Station| :| .............................................................|-|| (f) Revenue Demarcation/Hudbast No.| :| .............................................................|-| 4.| Location of Factory/Establishment| :| .............................................................|-|| (a)State| :| .............................................................|-|| (b)District| :| .............................................................|-|| (c)Municipality/Ward| :| .............................................................|-| 5.| (a)Whether the building/premises of Factory/Establishment is owned or hired|| .............................................................|-|| (b)If hired or there is a change in the name of unit/ownership, please indicate-|||-|| (i)ESI Code No., if covered earlier| :| .............................................................|-|| (ii)Date from which earlier Factory/Establishment closed down| :| .............................................................|-|| (iii)Terms and conditions under which property acquired/taken on lease (enclose copy of agreement/relevant deed)|||-| 6.| Details of Bank A/c:| :| (b)Name of Bank and Branch:|-|| (a)Account No..........................|| (i).......................................................|-|| (b)Account No..........................|| (ii).......................................................|-|| (c)Account No..........................|| (iii).......................................................|-| 7.| (a) Income Tax PAN/GIR No.| :| .............................................................|-|| (b).Income Tax Ward/Circle/Area| :| ..............................................................|-| 8.| Exact nature of work/business carried on| :| ..............................................................|-| 9.| Date of commencement of Factory/Establishment| :| ..............................................................|-| 10.| (a) Whether registered under Factories/Shop and Establishment/Other Act (Please Specify)| :| ..............................................................|-|| (b).Factory Licence No./Trade Licence No./Catering Establishment Licence No./Shop Establishment Registration No./Licence No. under Cinematography Act, etc.| :| License No.| Date| Licensing Authority|-|| (c)Please give whichever is applicable| :| No.| Date| Licensing Authority|-|| (i)Commercial Tax No.|| (i)|||-|| (ii)State Sales Tax No.|| (ii)|||-|| (iii)Central Sales Tax No.|| (iii)|||-|| (iv)Any other Tax No.|| (iv)|||-|| (d).Maximum no. of persons that can be employed on any one day, as per licence| :| ..............................................................|-| 11.| (a) Whether power is used for manufacturing process as per section 2(K) of the Factories Act. If so, since when| :| ..............................................................|-|| (b).In case of factory whether Licence issued under section 2(m)(i) or 2(m)(ii) of the Factories Act, 1948| :| ..............................................................|-|| (c).Power connection No.| :| No.| Sanctioned power load| Issuing Authority|-| 12| (a)Whether it is Public or Private Ltd. Company/Partnership/Proprietor-ship/Co-operative Society/Owner-ship (attach copy of Memorandum and Articles of Association/Partner-ship Deed/Resolution)|||-|| (b).Give name, present and permanent residential address of present Proprietor/Managing Directors, Director/Managing Partners, Partners/Secretary of the Co-operative Society| :| Name

(vii)| Designation

| Address|-| 13.| Address(es) of the Registered Office/Head Office/Branch Office/Sales Office/Administrative Office/other offices, if any,with no. of employees attached with each such office and person responsible for the office| :| Address as on date| No. of employees| Phone No./fax No.| Function| Person responsible for day-to-day functioning of the office|-|||| (Give details on a separate sheet, if required)|-| 14.| (a) Whether any work/business carried out through contractor/immediate employer| :| .....................................................................|-|| (b).If yes, give nature of such work/business| :| .....................................................................|-| 15.| (a) EPF Code No.| :| No.| Issuing Authority|-|| (If covered under EPF Act)||||-| 16.| Total number of employees employed for wages directly and through immediate employers on the date of application. (Whether manual/clerical/supervisor, connected with the administration or purchase of raw materials or distribution or sale of product/service, whether permanent or temporary).|-| | | | | | | | | | ||}

As on date	Total No. of employees	No of employees drawing wages Rs.7,500 or less
	Male	Female	Total	Male	Female	Total
Employed directly by the Principal Employer
Through Immediate employer/contractor
Total

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Union of India - Section

Section 109 in Employees' State Insurance (General) Regulations, 1950

109. [ Submission of additional information by employer or insured person.- [ Added by Noti. Noti. No. N-12/13/2/92-P&D, dated 22.4.1994 (w.e.f. 1.4.1994).]