FORM II

[Under rule 21(1) and rule 29 (2) of the Contract Labour (Regulation and Abolition) Central
Rules, 1971]

APPLICATION FOR LICENCE UNDER THE CONTRACT LABOUR (REGULATION AND

ABOLITION) ACT, 1970 (37 OF 1970)

Acknowledgement Number: 31032304030581 Date of Application: 31-03-2023

Details of Contractor
1. 1. Full Name of Contractor: HARIOM BUILDERS through SHRI JAI BHAGWANDAS GWALANI
2. 2. Full Address of Contractor : PLOT No. 29, WARD 3B, TAGORE ROAD, ADIPUR, Kutch,
Gujarat, - 370205
3. 3. LIN/PAN No. of Contractor: / AECPG3719C
4. 4. Email Id of Contractor: hariombuilders@yahoo.co.in
5. 5. Mobile No. of Contractor: 9825226644

Particulars of Establishment where workman is to be employed

1. 6. Name of Principal Employer: SHRI SATISH BATHURI - SR. MANAGER LPG ENGG, INDIAN
OIL CORPORATION LIMITED,LPG BOTTLING PLANT, Survey No. 474/7, Erracheruvupalli
Village, Puthalapattu Mondal, Chittoor, - 517124
2. 7. Number and Date of Certificate of Registration of the Establishment under the Act:
CLRA/ALCHYDRABAD1/2020/R-11 Dated 21-12-2020

Particulars of the Contract Labour

1. 8. Nature of work in which workman is employed or is to be employed in the Establishment:
CONSTRUCTION OF PLANT BUILDINGS, NON PLANT BUILDINGS, ROADS, DRAINS
CULVERTS AND MISC. WORKS AT IOCL LPG BOTTLING PLANT, CHITTOOR, ANDHRA
PRADESH
2. 9. Location of Work : IOCL, CHITTOOR BP PROJECT, SY No. 474/7, ERRACHERUVUPALL,
PUTHALAPATTU MANDAL, CHITTOOR, Chittoor, Andhra Pradesh - 517124
 3. 10. Duration of proposed Contract Work -
1. Date of Commencement of work: 20-03-2023
2. Date of Completion of work: 17-08-2023
4. 11. Name and Address of the Agent or Manager of Contractor at the work-site: MR. NARENDRA
SINGH - SITE INCHARGE, IOCL, CHITTOOR BP PROJECT, SY No. 474/7,
ERRACHERUVUPALL, PUTHALAPATTU MANDAL, CHITTOOR, Chittoor, Andhra Pradesh -
517124
5. 12. Maximum number of workmen proposed to be employed on the Establishment on any date:
150
6. 13. Whether a certificate by the Principal Employer, in Form III enclosed: Yes
7. 14. Work Order Number:
8. 15. Amount of Licence Fee : INR 150
9. 16. Amount of Security Deposit : INR 13500
10. 17. Jurisdiction for Licensing Officer : ALC Hyderabad I ( ALCHYDRABAD1 )

Signatur of Contractor
(eSign/DSC)
Note: This is an online application summary applied on Shram Suvidha Portal.

Digitally signed by JAI

BHAGWANDAS
GWALANI
Date: 2023.03.31
16:57:35 IST