Application for ISSUE / RENEWAL/CANCELLATION of Contract Labour Gate Pass

SL Description Details
No
1 Name of the Contractor
2 Contractor ID ( CLIMS ) :
3 Work ID ( CLIMS) :
4 PO No , date & Work details:

5 Work period as per PO: From: To:

6 Worker card to be issued / renewed for the period From: To:
7 Worker ID for gate entry to be issued / renewed for:
CLIMS ID/Name
1 11 21
2 12 22
3 13 23
4 14 24
5 15 25
6 16 26
7 17 27
8 18 28
9 19 29
10 20 30
8 Sunday & Holiday Pass required YES / NO
9 Attachments uploaded in CLIMS Purchase Order - Yes / No
( Please tick mark )/Submitted with HR Labour License - Yes / No / Not Applicable
ID proof of Contract workers - Yes / No
Police verification - Yes / No
I certify that the character & antecedent of the person proposed to be engaged by me for the above
contract work at NTPC Sipat establishment has been verified by me. Worker card / Employment card
of labour are enclosed.
□ Medical & Safety clearances of all the above worker are done.
□ Temporary Pass for Medical & Safety training may be permitted.

Seal & Signature of Contractor / Applicant

Name_____________________

The details of the workers furnished by the applicant have been checked and the case is recommended
for issue / renewal of gate pass.

Seal & Signature of EIC

HR Clearance: __________________________

CISF Clearance: _________________________

 Contract Labour's Temporary Gate Pass
1 Contractor Name CLIMS ID:

2 PO/LOA Number
3 Worker Name
4 Father's /Husband Name Photo
5 Sex(M/F) : Blood Group:

6 Date of Birth
7 Skill Level
Validity
8 ESI IP Number
From:.................................
9 Aadhar Number: Mobile No.: To:.....................................
10 Identification Mark
11 Present Address

Sign of Contractor Authorised Sign/Seal

Contract Labour's Temporary Gate Pass

1 Contractor Name CLIMS ID:

2 PO/LOA Number
3 Worker Name
4 Father's /Husband Name Photo
5 Sex(M/F) : Blood Group:

6 Date of Birth
7 Skill Level
Validity
8 ESI IP Number
From:.................................
9 Aadhar Number: Mobile No.: To:.....................................
10 Identification Mark
11 Present Address

Sign of Contractor Authorised Sign/Seal

Contract Labour's Temporary Gate Pass

1 Contractor Name CLIMS ID:

2 PO/LOA Number
3 Worker Name
4 Father's /Husband Name Photo
5 Sex(M/F) : Blood Group:

6 Date of Birth
7 Skill Level
Validity
8 ESI IP Number
From:.................................
9 Aadhar Number: Mobile No.: To:.....................................
10 Identification Mark
11 Present Address

Sign of Contractor Authorised Sign/Seal