| PROFORMA No.IV |
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(Self certification for IT based Industries, IT enabled services, Bio-Technology establishments, Exports Oriented Units and Units in Export Processing Zones under the Kerala Shops and Commercial Establishments Act, 1960 and the Kerala Shops and Commercial Establishments Rules, 1961 for the Calendar year ……) |
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Name & address of the Establishment (with building No., Telephone Nos. & PIN Code) |
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Registration No. under the Kerala Shops and Commercial Establishments Act, 1960. |
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Name (s) and address (es) of the employer (s) with residential address (Please specify the Telephone number) |
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| 4 |
Nature of commercial/ Industrial activities carried on |
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| 5 |
Total number of workers employed |
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a) Permanent |
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Male |
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Female |
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Total |
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b) Temporary |
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Male |
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Female |
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Total |
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b) Others if any (Specify) |
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Male |
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Female |
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Total |
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| Copy to: |
District Labour Officer (Enforcement) |
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| FOR OFFICE USE |
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| Date of receipt of the proforma in the office of the Authority ………………………………… |
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| Remarks of the Authority if any, |
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Signature: |
| Office Seal: |
Name & Address of the Authority |
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| Place: |
| Date: |
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