Building and Other Construction Application

Location : Dy. Director Industrial Safety and Health, Adipur

Application Year : 2024 Application No : 175

Application Date : 27/2/2024

Name of construction site : SURVEY 1154 CHADVARA

Site Location : 1154, SURVEY CHADVARA,

Establishment Name and : KOSOL ENERGIE PVT.LTD

Address: 193, SATYAGRAH CHHAVNI KLATHIA HOUSE, S.G.HIGHWAY OPP. ISKON TEMPLE,
Dist:Ahmedabad, Ta: Ahmedabad, PinCode: 380015
Principal Employer Information:

Principal Employer Name : BHARAT VEKARIA

and Address VEKARIA RAVJIBHAI, YOGINAGAR MAIN ROAD GONDAL, Dist: Kutch, Ta: Bhachau,
Pincode: 370140

Date of Birth (Principal Employer) :

Manager/Responsible Person's Information:
Name and Address : BHARAT VEKARIA
VEKARIA RAVJIBHAI, YOGINAGAR MAIN ROAD GONDAL

Nature of building or Other construction work : Electric Work

carried/is to be carried on in the establishment
Maximum Labour : 50

Date of Commencement : 30/11/2023 Date of Completion : 31/12/2024

Date of Birth (Manager/Responsible Person) :

Contractor's Details:

Name and Address :

,
Maximum Labour : Nature Of Work :
Additional Information:
Registration Fees: : 250

If payment is through Transaction ,

Transaction No. 2459768 , Transaction Date : 27/2/2024
Note:
You have to submit application with required document:
1. Passport Photograph
2. Proof of Residential Address
3. Proof of Establishment by Principal Employer/Contractor
4. Copy of Muster roll of building workers by Principal Employer/Contractor

Stamp
Applicant Signature
 FORM - IV
THE GUJARAT BUILDING AND OTHER CONSTRUCTION WORKERS (REGULATION OF EMPLOYMENT AND
CONDITIONS OF SERVICE)
RULES, 2003
See rule 26(3) and 55(1)]
NOTICE OF COMMENCEMENT/COMPLETION OF BUILDING OR
OTHER CONSTRUCTION WORK

(1) (i) Name and address (Permanent) of the KOSOL ENERGIE PVT.LTD
establishment 193, SATYAGRAH CHHAVNI KLATHIA HOUSE,S.G.HIGHWAY OPP. ISKON
TEMPLE,380,015
,

(ii) Name of the employer and address BHARAT VEKARIA

VEKARIA RAVJIBHAI,YOGINAGAR MAIN ROAD GONDAL,370,140,,

(2) Name and situation of place where the building SURVEY 1154 CHADVARA
and other construction is proposed to be carried 1154, SURVEY CHADVARA,,,
on.

(3) No. and date of Certificate of registration

(4) Name and address of the person in-charge of the BHARAT VEKARIA
construction work VEKARIA RAVJIBHAI,YOGINAGAR MAIN ROAD GONDAL

(5) Address to which the communications relating to KOSOL ENERGIE PVT.LTD

building or other construction work may be sent. 193, SATYAGRAH CHHAVNI KLATHIA HOUSE,S.G.HIGHWAY OPP. ISKON
TEMPLE,380,015,,

(6) Nature of work involved and the facilities including Electric Work
plant or machinery provided.

(7) The arrangement storage of explosives if any to

be used in building or other construction work.

(8) In case the notice is for commencement of work,

the approximate duration of work.
I/We hereby intimate that the building or other construction work (Name of work) having registration No………....... dated
............. is likely to commence/is likely to be completed with effect from............... (date)/on (date).

Signature of Employer

To :

The Inspector,

------------------------------------
------------------------------------
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 Annexure
Particulars of Contractors and Contract Labours
(Separate sheet may be used for each contractore)

SURVEY 1154 CHADVARA

Name and permanent address of contractor :
A. 1154, SURVEY CHADVARA,
Bhachau,Kutch

1154, SURVEY CHADVARA,,

Postal address of the contractor :
B. Bhachau,Kutch

BHARAT VEKARIA,VEKARIA RAVJIBHAI,YOGINAGAR MAIN ROAD

Name & Permanent address of the Responsible person
GONDAL
C. :

Nature of work in which contract labour is employed of Electric Work

D. is to be employed :

Maximum number of contract labour to be employed on 50

E.
any day through contractor :

Declaration :
(i) I/We hereby declare that the particulars given above are true the best of my knowledge and belief .
(ii) I/We undertake to abide by the provision of the Building and Other Contruction Workers (Regulation of
Employed & Condition of Service) Act 1996 and Rule made there under.

Date of Birth Resposible :

Date of Birth Contractor

with :

Signature of person

Signature
of Seal & stamp

Note :
(1) Proof of residential address should be furnished by each signatory.
(2) Proof of establishment should be furnished by the principle Eployer/Contractor
(3) Copy of muster roll showing employment of building workers should be furnished by principle
Employer/Contractor.