Madhya Pradesh Shops & Establishments Act, 1958

Application for Establishment Registration

Docket No. 664941 Date of Application : 17/11/2017
Name of Applicant : DINESH RATHOR
Father's / Husband's Name : MUNNA LAL RATHOR

Applicant's Status : Proprietor/Owner

Mobile No. : 9752360062
Address of Applicant : 39, SUKH SAGAR APPARTMENT NANAK NAGAR RING ROAD INDORE
Name of Shop / Establishment : DR Fabrication and Engineering Works
Address: LG-1 SHREE GANGA SQUARE KHANDWA ROAD District : INDORE
LIMBODHI INDORE
Shop Type (Employee Wise) : 1 to 3 Employees Day of Weekly Off : Sunday
Old Registration No. (if Any): Owner Type : Proprietorship
Business Type : Any Others Commercial Establishment
Category of Shop/Establishment : Commercial Establishment Business Start Date : 01/07/2017

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DECLARATION
I, DINESH RATHOR S/o / D/o / W/o. Mr. MUNNA LAL RATHOR do hereby solemnly affirm and declare that all information furnished by
me online and original documents scanned & uploaded by me along with this application are true to the best of my knowledge and belief and I
shall be responsible for any kind of false or fraudulent information and my Registration will be liable to be cancelled or withheld in any such
case without prior notice besides any other criminal/civil proceedings against me.

Signature of Applicant