THE ODISHA SHOPS & COMMERCIAL ESTABLISHMENTS RULES- 1958
FORM 1
(See Rules-4)
Application for Registration of an Establishment
1) Name of the employer and father's name : Shitalkumar Vinodray Mehta s/o Vinodray
/husband's name (in case of married female Mehta
employer)
2) Full postal address of the employer : Janata City Centre, Mouza-Alakapur,
Tahasil/Ps-Berhampur Town, Ganjam - 761026
3) The name(if any) of the establishment : Life Style International Private Limited (Max)
4) Full postal address of the establishment : Janata City Centre, Mouza-Alakapur,
Tahasil/Ps-Berhampur Town, Ganjam - 761026
5) Category of the establishment : Shop
6) The date on which the establishment : 29/10/2021
commenced work
7) No of employee/employees employed on the : 15
date of application
8) An amount of Rs. 450.0/- only has been paid in the STATE BANK OF INDIA on 12/11/2021 under
the head of account 0230-00-101-0014-02047-000 (challan No.3127427D7B dated 12/11/2021).
Date :12/11/2021 Signature of the Employer
FORM 5
(See Rule 11)
Notice of daily hours of work of employee
Commenced on : 29/10/2021
Name of Employer/ Establishment : Shitalkumar Vinodray Mehta / Life Style
International Private Limited (Max), Janata City
Centre, Mouza-Alakapur, Tahasil/Ps-Berhampur
Town, Ganjam - 761026
Registration Certificate No : New
Name of employee Sex From To From To
(FN) (FN) (AN) (AN)
Banamali Goud Male 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Santosh Kumar Sahoo Male 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Arun Jyoti Mohapatra Male 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Depuraj Nayak Male 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Santosh Raulo Male 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Sital Nayak Female 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Sivaprasad Raulo Male 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Kartik Sahoo Male 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Mamata Pradhan Female 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Chinmaya Kumar Sahu Male 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Gujuri Srikanta Male 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Saiprasad Sahu Male 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Madhusmita Dash Female 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Anupam Maharana Male 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Nikita Palai Female 9:30 AM 1:00 PM 2:00 PM 6:00 PM
Date :12/11/2021 Signature of the Employer
THE ODISHA SHOPS & COMMERCIAL ESTABLISHMENTS RULES- 1958
FORM 7
(See Rule 14 (1))
Name of Employer/ Establishment : Shitalkumar Vinodray Mehta / Life Style
International Private Limited (Max)
Registration Certificate No : New
Notice is hereby given that with effect from 12/11/2021 the establishment shall observe Wednesday as the
weekly holiday
Date :12/11/2021
Place :GANJAM
DECLARATION FOR NON-ENGAGEMENT OF CHILD LABOUR
I declare that no child labour is engaged in my establishment. I will be liable for prosecution under the Child
and Adolescent Labour (Prohibition and Regulation) Act,1986 if any child is found working.
DECLARATION
I hereby declare that the details given above are correct to the best of my knowledge and belief.
Signature of the Employer
