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Applicant Details
Applicant's Name*		Father's/Husband's Name*
Applicant Status *		Labour Identification Number (LIN)
Date of Birth(DD/MM/YYYY)*		Address of Applicant *
Mobile No*		Email
Alternate Mobile No.*		Applicant's / Corporate Pan Card Number Note: In case of proprietor/individual, please enter Applicant's PAN

Family Members / Other Partners involved in the business
Name of Family Member / Other Partner*		Designation*	Address *	Add Record

Shop / Establishment Details
Name of Shop / Establishment *		Address*
District*		Category of Shop/Establishment*
District Labour*		Business Start Date*
Shop Type (Employee Wise)*		Business Type*
Investment Type*
Risk Category*
Number of Employees: Male*		Number of Employees:Female*
Day of Weekly Off*		Owner Type*
MSME Sector  StartUp Sector  IT Sector

Manager Details

Manager Name*		Manager Father/Husband Name *
DOB(DD/MM/YYYY) *		Manager Mobile no*
Address *
Name of Accountant / Business Executive *		Executive Address *

Registration Fee Remittance Details
Registration Fee *		Compounding/Late Fee*
Total Paid Amount*