Madhya Pra~es~ Shops & Establishments Act, 1958 .

•
Application for Establishment Registration
Docket No. 1682553 Date of Ap 1• t·
· P •ca 100 : 21 /07/2021 .
Name of Applicant: SHAILA KATARIYA
Father's / Husband's Name : ASHOK JOSfil

Applicant's Status: Proprietor/Owner

Mobile No. : 96177614n
-~i•. · I ' r' , / ,')$

Address of Applicant: 3393-E, SUDAMA N~~AR, 'NEAR •~LOBAL 'stAOOL N

PRADESH : . . ,,' . ''','. ;., . . i . I ' ,,. I ,DORE, MADHYA
,: ' , .:.1< '. ',, _•:,: ;;: ,:',. :'{ ,: ,' , . '., •1} .
Name of Shop / Establishment : S~ .S~l);lJj~~TI'feyStO.CJA'.Rlt . :, , , .
Address: 749, USHA NAGAR EXTENSlQN
. . .)
'tN6oRE
•,,, ,
MP , ''n'·. • i:./ RE
,1Su., dt ., .
J IND
•--S,, :0,

Shop Type (Employee Wise) : 1 to

.
3Eniplo _ye~s
·; ., , . .
:,
. ,
.,. kl n_ ff , s ·
·D : , f W
.,. ayo _ .ee ·Yv ,· unday
Old Registration No. (if Any): \ ·, ·, · ·\ Ow · T · :· ; · to h'
. . · .·. ·.,,, :,\, . ner ype : ropr1e rs 1P
Busmess Type : Any Others Comme~i~l 'EstabHshmeut
Category of Shop/Establishment : Comm~~~i·~i'Eistitt~ishment
, : ·,1_1 . • •- l.,;,i.k:. ;\ n~~ir1e~s-&tart·n~~ : 2010112021
1

•~~tffcUl~c1 ~ ~ ~ ~ ~.~ '. ~ '.>i· :;;: ,, ,1

[ 1 il'ffe
• *
'/ ,Y/ ,, ; , 'i,'>), : ,_

~Rt~,lff t? .. ,'.·\;";{
[vi [ 1 il'ffe
-~ ~Ri~.zli cr
[ 1 [1.,1 il'ffe
• fa:ld-crll?i@c1 Gt-ct1a;;:i

1. Ju act,ii q:;"' q:;r tffic)-

[ 1~
2. q;)-c)- qfwr
[vl~ [ 1~
3. / t;;rt'r'
lv'f l 1
[\/]~ [ ] ~
5. * i>!UlQ-s ffi' ~~JJ=l.Ft)~o!sA 3ffq; :,Ftfl.tlffltt,ur l l~ lV!~
• cf,lJJ" ~tr c..(--c11a;;:i .(--9"!'/~ [V'J~ [ ]~
•<Rrr~~iTUTa{T~~ [V1~ [ ] ~
.q:m ttM d]<Jf [V1i [ 1~
• <RTr q:;r Fald-crl\?i@c1 rn V1 [ ] alffe
1. ~f.,:; l l [0 alffe
2. t,;rfr • [\/1 [ ] alffe
3.•~~~IDf!'~tTicJcft"cftr'~ [ ] [v1 alffe
[Vf~ [ ]ifffe
• cRl1" q:;r 9':f t [vf [ ] ifffe
• q:m ~arr q:;r 9':f cf c.h11~;;il t (/T [ ] ifffe
• cf;RUT [ l err :
DECLARATION
I, SHAIIA KATARIYA S/o I D/o I Wlo. Mr. ASH OK JOSHI do hereby solemnly affirm and declare that all information furnishe~ by me
online and original documents scanned & uploaded by me along with this application are true to the best of my knoV.:ledge ~d belief and I shaU
be responsible for any~d of false or~~ent-~rmatio1:-and fflJ'. Registration will be liable-to be cancelled or e many such case
without prior notice besides any other cnminal/c1vil proceedings against me.