Registration Form For Industry
 
Industry Infromation     
     
Name of Industry (As display on the PAN Card)* :
PAN Card Number* :         
GSTIN Number* :         
       
Industry Address        
       
Address/Locality*   City/Town/Village :   
Tehsil/Post Office :    District*  
State* Haryana   PinCode*  
       
Contact Person Details     
       
Training Coordinator*   Designation*  
Mobile No.*   Email ID*  
       
Number of Employees       
 
     First Aid Professional training to 30% of the total employees (including Regular, Contractual, Out Source, Daily Wages or by any other mode
for Both Security Guards and other Employees) for every Industry and 100%  Security  Guards has been mandatory in the State of Haryana
 
  Valid Certificate : Date of issue should not be more than 3 years old  
   * All fields of this section are mandatory  
  Regular Contractual Out Source Daily Wages Total No. of Employees Already
Trained with valid Certificate
Employees (other
than Security Guard)
Security Guards
       
       
   
Choose Password     
    Password must be between 8 to 20 character length, must contain at   
least one number, one uppercase letter and one lowercase letter.   
       
Password*   Confirm Password*  
       
Security  Code        
   
 
   
Enter Security Code¬†*¬†:         
 
 
   I hereby declare that the information given in this application is true and correct to the best of my knowledge