The Bombay Shops and Establishments Act, 1948


FORM A ""
(See Rule 5) ( )
Application under Section 7(1) ()   "
U.T.N. / ...
Establishment Code /
Status / 
1

Name of the Establishment, if any

 

Postal address and situation of the establishment

 

City / Village / /
District / 
State / "
Pincode / #
3

Whether the establishment falls under Public

Sector or Private Sector (See Notes 4 and 5 below)
$ & ( &
( )

Situation of Office, Store Room, Godown, Warehouse, or Work Place, if any, attached to Shop but situated in
premises different from those of the Shop.
/ 0 2 3 $, , , 3
,   7

5, 6

Names and Addresses of the employer



Employer / $
7

Name of the Manager, if any

8   7
Residential address of Manager, if any
8   70 

Email Address of the Manager

8   7 - 
Phone Number of the Manager
8   7 :
Fax Number of the Manager
8   7 =
8

Type,Category and Sub-Category of the establishment, i.e. whether a Shop,

Commercial Establishment, Residential Hotel, Restaurant,
Eating House, Theatre or other place of Public Amusement
or Entertainment.
? , 8 , / ,
, , $ 3 ( 3
3 .

Nature of Business
C D

10

Date of commencement of business

E  

11

Names of members of employer's family employed in the establishment / :   0

8G( .

Family Members Details / '(

12

Names of persons occupying position of management or employees engaged in confidential capacity /

8 3 D I  .

Management Staff Details / ' '(

13

Total Number of Employees

J
Adults / *

Adolescents / -

Males /
Females / "
Total /

Establishment's Weekly Off

K3 L
File Reference Number
$
Payment Details /
Applicable fees / 
Total fees to be paid / I =
Receipt No. /

Receipt Date / 3

Payment mode / $

Challan No. /

Challan Date / 3

Treasury Bank /

Fees Paid / 

For office use only / 5 9

Division / #

District / 

Taluka /

Ward /

Communication will be sent on / : - 5 <

Mobile No. / :

Email / -

Total /