Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697804497421.pdf (India)
Self-declaration by the Contractor for Issuance/Renewal of License for Contractor under Contract Labour ( R & A ) Act, 1970.

I/We, Shri M/s.

…………………………………………………………………………………………………… (Name and Address of the Contractor) hereby intimate that the contract work ……………………………………………………………………………………………………<(Name of Work)> the establishment of ……………………………….

………………………………………………………….in …………………………………………….. (Name and Address of Principal Employer) for which Registration No.
………………………Dated………………………has been issued to me/us by the Licensing officer (Name of the District) has been commenced / completed with effect from date/on date………………….. And I further declare that: 1.

I shall comply with all provisions of Contract Labour Act (R&A) 1970 and its subsequent notified amendments.

2.

I shall pay as per the notified/revised minimum wages by Labour Department, GNCTD to these contract Labourers in accordance with Minimum Wages Act, 1948 3.
I shall disburse all payments including payment of wages in time as per provision of relevant act to my contract workers via Account Payee Cheque/ ECS transfer only.

4.

I shall comply with all provisions of ESI and PF and shall deposit the statutory deductions in a timely manner.

5.

I shall not employee any minor as per the provisions of the Child Labour (Prohibition & Regulation) Act, 1986 6.
I ensure for legal compliance including condition of licence Rule-25 of the Rules I affirm that I shall comply with all the above stated declaration and in case of non- compliance of any of the above declaration; the Proprietor/ Directors/ MD of the organization shall be liable to penal action as per the provisions of the IPC applicable to the above acts.
The details of the Proprietor/ Director/ MD along with other details are as follows: S.No Name Position Address ID Proof* *Only Aadhaar/Passport/PAN Number/Voter ID are acceptable as ID proof (please add additional Sheets if applicable) Verification as under:- (i) (ii) That the above declarations and information furnished are correct to the best of my knowledge and belief and nothing has been concealed in any manner whatsoever.
If any information/undertaking furnished by me is found to be wrong, false in that event I shall be liable for penal action as provided under the provisions of Contract Labour (Regulation & Abolition) Act 1970, Indian Penal Code and other relevant laws.

(iii) I shall be personally bound and responsible for all acts of omission and commission.
Date: DD MM 20YY Signature Place: ______________________ --------------------------------------------------------------------- Name of Authorized Representative of Contractor Company Seal Self-declaration by the Principal Employer for Registration Certificate under Contract Labour ( R & A ) Act, 1970.

I/We, Shri M/s.

…………………………………………………………………………………………………… (Name and Address of the Principal Employer) hereby intimate that the contract work …………………………………………………………………………………………………………………………………….
<(Name of Work)> …………………………..………………………………………………………….given to ……………………………….

…………………………………………….. (Name and Address of Contractor) having Registration Certificate No.

………………………Dated………………………has been commenced / completed with effect from date/on date………………….. And I further declare that: 1.

I have not been employed and shall not employ workers directly for the work for which the contract workmen have been employed through a contractor and if so, there is/shall be no violation of Rule-25(2) (v) of the Rules.
In case I do, I shall be fully responsible for the same.

2.

I am registered under the Delhi Shops and Establishments Act 1954 and under Factories Act 1948 with registration number :……………………………….

3.

I shall pay as per the notified/revised minimum wages by Labour Department, GNCTD to these contract Labourers in accordance with Minimum Wages Act, 1948 4.
I shall disburse all payments including payment of wages in time as per provision of relevant act to my contract workers via Account Payee Cheque/ ECS transfer only.

5.

I shall comply with all provisions of ESI and PF and will deposit the statutory deductions in a timely manner.

6.
6.

I shall not employee any minor as per the provisions of the Child Labour (Prohibition & Regulation) Act, 1986 I affirm that I shall comply with all the above stated declaration and in case of non- compliance of any of the above declaration; the Proprietor/ Directors/ MD of the organization shall be liable to penal action as per the provisions of the IPC applicable to the above acts.
The details of the Proprietor/ Director/ MD along with other details are as follows: S.No Name Position Address ID Proof* *Only Aadhaar/Passport/ PAN Number/ Voter ID are acceptable as ID proof (please add additional Sheets if applicable) Verification as under:- (i) (ii) That the above declarations and information furnished are correct to the best of my knowledge and belief and nothing has been concealed in any manner whatsoever.
If any information/undertaking furnished by me is found to be wrong, false in that event I shall be liable for penal action as provided under the provisions of Contract Labour (Regulation & Abolition) Act 1970, Indian Penal Code and other relevant laws.

(iii) I shall be personally bound and responsible for all acts of omission and commission.
Date: DD MM 20YY Signature Place: ______________________ -------------------------------------------------------------------- Name of Authorized representative of Establishment Company Seal