Name of Employer (required)
Name of the Institution (required)
PIN code (required)
Phone Number (required)
Email Address
Village (required)
Select your District (required) Please SelectAlappuzhaErnakulamIdukkiKannurKasargodKollamKottayamKozhikodeMalappuramPalakkadPathanamthittaThiruvananthapuramTrissurWayanad
Police Station (required)
Address (required)
PAN Card Number of the Employer / Institution (required)
Select one of the License (required) Please SelectLabour licenseFactory licenseAffiliationVAT Registration
License Number (required)
20 or more employees list if available Sl No:, Employee Name, Date of Birth (DD/MM/YYYY), Name of Father/Husband
Type of Institution (required) proprietorshippartnership firmprivate limited companypublic limited companytrustsocietyboardcorporation
Nature of Business (required)
Bank Details
Account Number, Name of Bank, Branch, IFSC, MICR Number
File Uploads
Upload a scanned copy of PAN Card or send a Photo-copy in regular mail
Upload a scanned copy of Cheque/DD or send a Photo-copy copy in regular mail
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