Annexure-A

S.No. Particulars/Details Description Particulars/Details
1 NAME AND ADDRESS OF CONTRACTOR's ESTABLISHMENT Shubham Facility Services
2 WEBSITE ADDRESS shubhamfacilityservices.co.in
3 NAME AND ADDRESS OF THE PROPRIETOR/Director/Partners Mrs. Reena
4 PHONE / MOBILE NUMBER EMAIL ID OF THE ESTABLISHMENT/ PERSON IN-CHARGE of contract work +91-9810228713,
shubhamfacilityservices@gmail.com 
5 NAME AND ADDRESS OF THE PLACE/ SITE WHERE THE CONTRACT WORKERS ARE TO BE EMPLOYED
6 PHONE / MOBILE NUMBER EMAIL ID OF THE PERSON INCHARGE OF THE SITE
7 Copy of MOA/ AOA/ Partnership Deed/ Proprietor's ID Proof
8 FORM V ISSUED BY P E RULE 21(2)
9 NOTICE OF COMMENCEMENT/ COMPLETION RULE 25(2)
10 FORM IV RULE 21(1) / VII RULE 29(2)
11 AGREEMENT WITH P.E. ALONG WITH RATES AND NO OF WORKERS ARE TO BE ENGAGED/ EMPLOYED
12 LETTER OF EXTENSION of contract period, in CASE OF RENEWAL  
13 AFFIDAVIT THAT THE WAGES ARE BEING PAID THROUGH ACCOUNT PAYEE CHEQUES/ECS
14 AFFIDAVIT FOR LEGAL COMPLIANCE INCLUDING CONDITION OF LICENSE
15 Challan of License Fess/(late Fees, if any) G.A.R-7
16 Challan of Security Deposit (G.A.R-7)
17 License No. under CLRA Act,1970
18 Nature of work for which Contract workers are to be engage/employed
19 Registration Number/certificate under the Delhi Shops & Establishment Act 1954
20 PF Code Number
21 ESI Code Number
22 Half Yearly Return-Rule 82(1)
Part-B
1 NAME AND ADDRESS OF THE PRINCIPAL EMPLOYER
2 WEBSITE ADDRESS
3 NAME AND ADDRESS OF THE Proprietor/Director/Partner of P.EEstt.
4 PHONE/ MOBILE NUMBER OF THE PERSON INCHARGE OF THE CONTRACT WORK SITE
5 Registration Certificate No. under CLRA Act,1970