Form - B

Application for Registration

Prescribe under sub Rule (2) & (3) of rule 4 of the
West Bengal Shops & Establishments Rules 1964.
PART - 1
To
The Registering Authority
Shops & Establishments
(Here specify the area & Address)

Sir,
I hereby apply for registration of my Shop/Establishment under the West Bengal Shops and
Establishments Act, 1963. Particulars about the Shop/Establishment are furnished in statement
below.
Required fee for Registration Rs 50 are deposited in this connection.
STATEMENT
1. Name of the shop/establishment. If any SHRIRAM FINANCE LIMITED
2. Postal address and exact location of the 2ND FLOOR, ABOVE UNION BANK
shop/establishment. BUILDING, VILL THANA COLONY,
WARD NO 12, NH 31, OPP ISLAMPUR
BUS TERMINUS, ISLAMPUR, Ward No.
- 12, ISLAMPUR MUNICIPALITY,
ISLAMPUR SUB DIVISION, P. O. -
ISLAMPUR S.O (NORTH DINAJPUR)
District: UTTAR DINAJPUR
Pin Code: 733202
Police Station ISLAMPUR
3. Exact location of office, store-room, godown, 2ND FLOOR, ABOVE UNION BANK
warehouse or work place, if any attached to shop but BUILDING, VILL THANA COLONY,
WARD NO 12, NH 31, OPP ISLAMPUR
situated in premises different from those of BUS TERMI
shop/establishment.
4. Name of shop-keeper/employer. SOURAV GHOSH
5. Residential address of shop-keeper/employer 2ND FLOOR ABOVE UNION BANK
BUILDING VILL THANA COLONY
WARD NO 12, NH 31, OPP ISLAMPUR
BUS TER, Ward No. - 12, ISLAMPUR
MUNICIPALITY, P. S. - ISLAMPUR, P.
O. - ISLAMPUR COURT S.O, UTTAR
DINAJPUR - 733202
6. Name of manager, if any, and his Residential SOURAV GHOSH
address. 2ND FLOOR ABOVE UNION BANK
BUILDING VILL THANA COLONY
WARD NO 12, NH 31, OPP ISLAMPUR
BUS TER, ISLAMPUR MUNICIPALITY,
P. S. - ISLAMPUR, P. O. - ISLAMPUR
S.O (NORTH DINAJPUR), UTTAR
DINAJPUR - 733202
7. Name and residential address of Partners, N/A
(if a partnership concern)
8. Name and residential address of Directors 1. Mr. Y S Chakravarti
(if a limited company) SHRIRAM FINANCE LIMITED, 14A,
SRI TOWERS, SOUTH PHASE,
INDUSTRIAL ESTATE, GUINDY,
CHENNAI 600 032, TAMIL NADU.,
TAMILNADU

2. Umesh Govind Revankar

 SHRIRAM FINANCE LIMITED, 14A,
SRI TOWERS, SOUTH PHASE,
INDUSTRIAL ESTATE, GUINDY,
CHENNAI 600 032, TAMIL NADU.,
TAMILNADU

9. Category of establishment i.e., whether a shop COMMERCIAL ESTABLISHMENT

commercial establishment, residential hotel,
restaurant, eating house, theatre, cinema, or other
place of public amusement or entertainment.
Establishment MSME Type. Large
10. Nature of business NBFC
11. Date of commencement of business 13/06/1979
12. Names of members of owner's family employed in the shop/establishment who live with the
owner and are dependent on him/her.
Relationship Adults Young persons
Males N/A 0 0
Females N/A 0 0
Total 0 0
13. Names of other persons employed :-
i) In a managerial or confidential capacity N/A
ii) As a traveller, canvassar, messenger, N/A
watchman, or caretaker; and
iii) exclusively in connection with customs N/A
examination, collection, despatch, delivery, or
conveyance of goods from or to booking
officers for transport by rail, road or air, docks
werehouses or airports (indicate sex and age in
case of young Persons)
14. Total number of employees :-
Adults Young persons Total
Males 14 0 14
Females 0 0 0
Total 14 0 14
15. Declaration of weekly close days (in the case of a Full close day SUNDAY
shop or commercial establishment.) Half close day SATURDAY
Employer Email bijoy.chakraborty@shriramfinance.m
e
Employer Mobile No. 7001345813
Employer AADHAR No. XXXX XXXX X954

I hereby declare that the above information is true to the best of my knowledge and belief
and that all the provisions of West Bengal Shops & Establishments Act, 1963 have been
complied with.

Yours faithfully
 Dated. Signature of shop-keeper/employer
NOTE 1. Item 3 should be filled in only when the office, store room etc. are not separately
registered under the Act. In respect of such store rooms etc. not separately registered,
particulars required under Items 12, 13, 14 should be given separately for each office,
store room etc.
2. If any item is not applicable, enter "Not applicable".

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