Worker Registration Form (Form No. 28)

General Information Details of Place of Working
District :*
Name of circle of the officer(if you are not sure about the circle of the officer then don't fill it):
Name of the circle of the Inspector(if you are not sure about the circle then don't fill it) :
Area (if you are not sure about the area then don't fill it):
Type of Work :*
Name of Worker :*
Upload Photo :*
Scan your photo and upload here
Name of Husband/father :*
Category :*
Date of Birth :(Between 18- 60 Yrs)*
Scan proof of your birthdate upload here
Qualification :
Gender :
Marital status :
Aadhaar Card No: *
Identity proof(Any one of these)
Scan your identity proof and upload here
Current Address
District :*
Sub Div. :*
Pincode :
Email Address :
Mobile number:*
Phone number :
Are you Migrant? If yes,fill the details below Current Department Details Where you are working (If Applicable)
Department Name :
Department Address :
Upload Working (Form No. 27) (Self decelaration attested by sarpanch/mc) :*
Employer Name :
Employer Address :
Whether applicant is already a member of any other Board? If yes, fill the details below:- Bank account details of the worker for transferring benefits
Name of the Bank :*
Branch :*
Bank Account Number :*
Scan your passbook/bank statement/Cancelled cheque (viewing name and a/c) and upload here
IFS Code :*
ESI Number :
EPF Number :
Give detail of Family member as per definition of family given as under:- "family" means the husband or wife, minor sons (including major sons who are insane or physically handicapped and unable to earn), unmarried daughters and the parents of the building worker, who are solely dependant on him.
Serial Number Name of the member Relationship with the worker Gender Nominee Age Qualification Do you want to acquire skill upgradation/ Vocational Education Upload Photo Upload Nominee (Form-29) Document Add More +
Scan your family photo & upload here
Scan your Nominee Document & upload here
Other Information
Work experience :
I declare that the contents given above are true and correct to the best of my knowledge and belief.
Signature :*
Scan your signatures and upload here
Thumb impression:*
Scan your thumb impression and upload here
  • offline
  • online
Worker Reg Number :
Demand Draft Number/Receipt No:
Date :
Amount :
Proof Of Challan:
Name Of Bank :
Worker Reg No :
Start Date :
Number Of Months :
End Date :
Amount :
Your Registration Details have been Saved. Kindly check your E-mail for Temporary Registration Number and wait for Officer's Approval.
Do You Want To ?