Ashadip PSC

Establishment Category *

Commercial Establishment Factory Eating House Mine Other Places of Public Entertainment or amusement Residential Hotel Restaurant Shop Theatre Other

Sector (Ownership Type) *

Central Govt. Controlled Central Govt. Department State Govt. Controlled State Govt. Department Central Public Sector Undertaking State Public Sector Undertaking Co-Operative Society Firm Run By Trust HUF Limited Liability Partnership(LLP) Local Bodies / Municipal Corporation Partnership Firm Private Limited Company Public Limited Company Proprietorship Firm Registered Society

Establishment Name (as per PAN) *

PAN Number *

Date Of Registration *
(e. g. dd/mm/yyyy)

Registration/ Deed/ CIN No *

No Of Owners *

Issued By *

Issued At *

Work Place Address *
(Mention - Permise No. or Name / At. or Vill / Street Name / P.O / P.S / Dist. / State / Pin No )

MSME Certificate No

MSME Certificate date
(e. g. dd/mm/yyyy)

DIPP Start-up Certificate No

DIPP Start-up Certificate Date
(e. g. dd/mm/yyyy)

If Factory, Specify Factory License Details
(Mention - Factory Licensed Under Section / Date of License Registration / Factory License Number / Date of Trial Production / Issued By Authority, Place)

Primary Mobile Number *

Primary E-Mail Id *

Name *
Address *
Email *
Phone No *

Name *
Father Name *
Gender *	Male Female Transgender
Date of Birth * (e. g. dd/mm/yyyy)
Designation *
Date From which in Position * (e. g. dd/mm/yyyy)
PAN Number *
Full Address with Pin No * (Mention - Permise No. or Name / At. or Vill / Street Name / P.O / P.S / Dist. / State / Pin No )
Mobile Number *
E-Mail Id *

Name *
Father Name *
Gender *	Male Female Transgender
Date of Birth * (e. g. dd/mm/yyyy)
Designation *
Date From which in Position * (e. g. dd/mm/yyyy)
PAN Number *
Full Address with Pin No * (Mention - Permise No. or Name / At. or Vill / Street Name / P.O / P.S / Dist. / State / Pin No )
Mobile Number *
E-Mail Id *
If Want to Add more then one Owners, Please download this below attached file and fill up and upload OWNER DETAILS.xlsx

Select Identifier *
Identifier value *
Name as on Identifier *
Date of Issue * (e. g. dd/mm/yyyy)
Issued by (Authority) *
Issued at (Place) *
Mark it as Address Proof	Yes No

1. Do EPF and MP Act applies to Establishment *	Voluntary Coverage Application Yes
Number of Employees (Including Excluded Employees) As On Date Of Application *
Number of Excluded Employees *
Date On Which the Employment Strength Exceed 19 (e. g. dd/mm/yyyy)
Date Of Aggreement between Employer and Employees Majority (e. g. dd/mm/yyyy)
Any Subsequent Date Mentioned in The Agreement (e. g. dd/mm/yyyy)
Date from Which Act Will Be Applied (e. g. dd/mm/yyyy)
2. Is Establishment Multinational *	Yes No
3. Whether Any work/Business is being carried out through contractor/immediate employer *	Yes No
4. Is there any Hazardous activity in your establishment *	Yes No
Number of Workers as on date (Mention No of Male, Female, Other Worker)
No of Employees drawing wages Rs. 21,000 or less (Mention No of Male, Female, Other Worker)
First date on which 10/20 or more persons were employed (including persons employed through immediate employers) * (e. g. dd/mm/yyyy)
Total wages paid in the preceding month
Other Details
Whether the building/premises of factory/Estt is owned or hired *	Hired / Rented Leased Owned
If Rented or Leased, Please give Lessee Details (Mention Lessee - Name, DOB, Father Name, Mobile, Residential Address)

Miscellaneous License/Registration

Form - E.S.I/E.P.F.O Registration(Employees Provident Fund Organization)

Total Expenses : Rs 3540/-

:: Contact Person Details ::

ORGANIZATION DETAILS

PRIMARY MANAGER DETAILS

PRIMARY OWNER DETAILS

IDENTIFIER DETAILS

EMPLOYMENT DETAILS

BRANCH / DIVISION DETAILS

ACTIVITY DETAILS

DOCUMENTS

(Scan on Original Copy in 300 dpi color in jpg/PDF format , Maximum size limit is 1 MB per file

SPONSORED INFORMATION AND FINAL SUBMISSION

APPLICANT DETAILS

Our Team

Kiran Bala Dey

DEBIKA SUBBA

Nisha Sarki

Jharna Mallick

ARPITA CHAKRABORTY BANERJEE

PRIYA BISWAKARMA

Chhanda Barik

Gopal Bera

ANINDITA ROY

Mousumi Pal

Contact Info

Visit Us

Mail Us

Call Us

Feel free to write your query

ASHADIP PSC

Name of Unit
Relationship Type	Additional Establishment Ancilliary Unit Branch Factory For Handing PF Exemption Liasion Office Head Office Sales Office Para 27 27A
No. of Members in the Branch
Name of Responsible Person for Office
LIN
Full Address with Pin No (Mention - Permise No. or Name / At. or Vill / Street Name / P.O / P.S / Dist. / State / Pin No )

Primary Business Activity *
Nature of Work *	Chemical and Chemical Products Cinemas and Theatres Commercial Establishment Educational Institution Engineering Food Beverages and Tobacco Hospital Nursing Home etc Hotel Restrurent Leather and Rubber Metallic Minerals Miscellaneous Non Metallic Minerals Paper and Printing Textiles Transport
Subcategory of Nature of Work *

Attachement as Proof of Address * ( Any License/Certificate issued by any Govt. Authority / Water Connection name of Establishment / Post Paid Telephone Bill name of Establishment / Electric Bill name of Establishment )
Incorporation Certificate / Partnership deed containing list of Partners or Authorization Letter / Business Registration Certificate *
Licence Proof Attachment *
Specimen Signature Attachment * Specimen Signature Attachment.pdf
Others

NAME *
DATE OF BIRTH * (dd/mm/yyyy)
GENDER *	Male Female Trans Gender
FULL ADDRESS WITH PIN NO *
MOBILE NO *
E-MAIL ID
AADHAAR NO *
PAN NO *

Sponsored Name *	Yes No
If Yes, Give the Sponsored Username