Labour Commissioner 
To,
The Labour Commissioner
Govt. of NCT of Delhi
5 Sham Nath Marg
Delhi
SUB: Application for Exemption from provisions of Shops & Establishment Act 1954
Sir,
The undersigned is Proprietor/ Partner/ Manager for establishment as per the following particulars.
| 1. | Name & Address of Establishment: | |
|---|---|---|
| 2. | Name of the Proprietor / Partner / Manager : | |
| 3. | Registration No. under S&E Act: | |
| 4. | Nature of Business: | |
| Retailer / Shop / Manufacturer / Corporate Office / Society / Place of Entertainment / Others i.e | ||
| 5. | No. of employees: Male: Female:: Children: |
|
| 6. | Working Hours: | |
| 7. | Weekly off day: | |
| Shift Timings No of persons in each shift: |
||
| 8. | Interval for rest _______ to ________, Interval for meals _______ to _______ | |
| It is requested that exemption may kindly be given under section 14 and / or section 15 and /or section 16 of the S&E Act 1954 in following respect till 31st March 2003. | ||
| 9. | Extend /Change working hours from- AM to AM and PM to PM | |
| 10. | Allow opening of Establishment on: Weekly off / National Holiday. | |
| 11. | List of employees with designation who will work after the normal working hours and details of benefits which shall be given to them is attached. - Yes No |
|
| 12. | A copy of intimation circular given to these employees to this effect with their signatures obtained on the circular is attached. - Yes No |
|
| Dated: | (Signature of Applicant) | |
| Name & Designation: | ||
| Seal of Establishment: | ||
| Undertaking | ||
| 1. Employer shall make suitable arrangement regarding safety, security and transportation of all the employees, who have been asked to work overtime. | ||
| 2. Overtime wages should be paid to eligible employees at double rate of wages and in accordance with the provision of Delhi Shops & Establishments Act, 1954. | ||
| 3. Employees working on National Holidays shall be given compensatory leave in lieu thereof and double rate of wages as overtime. | ||
| 4. Weekly off day will be allowed to employees in rotation. | ||
| 5. Shift working shall be by rotation so as to ensure that no employee is forced to work in night shift only. | ||
| 6. A copy of this order shall be displayed on the Notice Board by the Employer. | ||
| Dated: | (Signature of Applicant) | |
| Name & Designation: | ||
| Seal of Establishment: | ||