Principal Employer Checklist

ANNEXURE-A
ParticularsDescriptionPDF Attachment
Name and Address of the P.E.Fortis Healthcare Ltd (Fortis Hospital) A Block,
Shalimar Bagh, Delhi - 110088
Website Address https://www.fortishealthcare.com/india/hospitals-in-delhi-ncr/
fortis-hospital-shalimar-bagh/principal-employer
Name and Address of the Proprietor/Director/PartnersMr. Mahipal Bhanot (Zonal Director) Fortis Hospital,
A Block, Shalimar Bagh, Delhi - 110088
Phone/Mobile Number and E-mail I.D. of establishment/person in-charge of contract work Ms. Shubhra Kohli, Unit Head - Human Resources Mobile : 9911129588
E-Mail ID : shubhra.saxena@fortishealthcare.com
Mr. Rajeev Kumar, Human Resources Mobile : 8447738045
E-Mail ID : rajeev.kumar2@fortishealthcare.com
Name and Address of the place/site where the contract workers are to be employed Fortis Healthcare Ltd (Fortis Hospital)
A Block, Shalimar Bagh, Delhi - 110088
Phone/Mobile Number and E-mail ID of person in-charge of the site Ms. Shubhra Kohli, Unit Head - Human Resources Mobile : 9911129588
E-Mail ID : shubhra.saxena@fortishealthcare.com
Mr. Rajeev Kumar, Human Resources Mobile : 8447738045
E-Mail ID : rajeev.kumar2@fortishealthcare.com
Copy of Power of Attorney/Board resolution authorizing to act as P.E.Power of Attorney in the name of Zonal DirectorPower Of Attorney - FD
Copy of MOA/AOA/Partnership Deed/Proprietor's I.D. Proof Memorandum & Certificate of IncorporationMemorandum & COI - FHL,Memorandum & COI - FHTL
Nature of Work for which contract works are to be engaged/employed As per Annexure - B Given below
Form "V" issued by P.E. to each contract - Rule 21(2)Form VForm V Swift Securitas
Form V Dynamic Services
Form V Invisible Kitchen Pvt Ltd
Notice of commencement/completion of contract work Rule 21(2)Form VI B
Application in Form I - Rule 17(2)Application submitted for Renewal of Reg. CertificateRC Application FHL
Agreement with each contractor along with rate & no. of worker for which contract has been givenValid Contracts & Extension of Contracts
Letter of extension of contract period issued to contractors, in case of renewal of licenceExtension of Contracts
Affidavit by P.E. regarding compliance of Rule 25(2)(V) and that wages to contract worker are being paidSelf Declaration by Principal EmployerSelf Declaration by Principal Employer
Name and Designation of the person authorized under Rule Ms. Shubhra Kohli, Unit Head - Human Resources
Mobile : 9911129588
E-Mail ID : shubhra.saxena@fortishealthcare.com

Mr. Rajeev Kumar, Human Resources
Mobile : 8447738045
E-Mail ID : rajeev.kumar2@fortishealthcare.com
Challan of Registration Fees(G.A.R-7)N.AN.A
Registration Certificate No. under C L R A Act, 1970CLA/PE/02/NW/2010 dated 18.01.2010RC FY 18-19
Registration Number/Certificate under the Companies Act,1956Memorandum & Certificate of IncorporationMemorandum & COI - FHL,Memorandum & COI - FHTL
Registration Number/Certificate under the Delhi Shops&Establishment Act,1954/Factories Act,1948Certificate under Shops & Commercial Establishment ActCertificate under Shops & Commercial Establishment Act
Copy of application for AmendmentApplication submitted for Renewal of Reg. CertificateRC Application FHL
Annual Return-Rule 82(2)Annual Returns CLA Form 25
ANNEXURE-B
Name & address of the contractor establishmentWebsite LinkNature of work of contractPeriod of contractMaximum number of workers
employed by each contractor
Swift Securitas Pvt Ltd, 2, Rajdhani Enclave, Near Rani Bagh,Pitampura, New Delhi-110034
Contact Person: Mr. Anil Mago
Mobile : 9717997174
E-Mail: anil.mago@swiftsecuritas.in
https://swiftsecuritas.in/Security services01-Apr-2031-Mar-218
Dynamic Services, A-100, Ratan Appartment, Raju Park, New Delhi - 110062
Contact Person: Mohammed Ejazul Bari
Mobile : 9811009550
E-Mail : dynamicaziz@gmail.com
https://dynamic-services.in/General Duty Assistant01-Apr-2031-Mar-21180
Prime Facility Services, 1730, Near Bus Stand, Rajpura, Patiala, Punjab
Contact Person: Mr.Chander Shekhar Sharma
Mobile : 7827251970
Email : sanjay.ojha@invisiblekitchens.com
https://www.primefacilityservices.comFood & Beverges01-Apr-1931-Mar-2290



For more details/queries, please write to us at reachus@fortishealthcare.com

ANNEXURE-A
ParticularsDescriptionPDF Attachment
Name and Address of the P.E.Fortis Healthcare Ltd (Fortis Hospital) A Block,
Shalimar Bagh, Delhi - 110088
Website Address https://www.fortishealthcare.com/india/hospitals-in-delhi-ncr/
fortis-hospital-shalimar-bagh/principal-employer
Name and Address of the Proprietor/Director/PartnersMr. Mahipal Bhanot (Zonal Director) Fortis Hospital,
A Block, Shalimar Bagh, Delhi - 110088
Phone/Mobile Number and E-mail I.D. of establishment/person in-charge of contract work Ms. Shubhra Kohli, Unit Head - Human Resources Mobile : 9911129588
E-Mail ID : shubhra.saxena@fortishealthcare.com
Mr. Rajeev Kumar, Human Resources Mobile : 8447738045
E-Mail ID : rajeev.kumar2@fortishealthcare.com
Name and Address of the place/site where the contract workers are to be employed Fortis Healthcare Ltd (Fortis Hospital)
A Block, Shalimar Bagh, Delhi - 110088
Phone/Mobile Number and E-mail ID of person in-charge of the site Ms. Shubhra Kohli, Unit Head - Human Resources Mobile : 9911129588
E-Mail ID : shubhra.saxena@fortishealthcare.com
Mr. Rajeev Kumar, Human Resources Mobile : 8447738045
E-Mail ID : rajeev.kumar2@fortishealthcare.com
Copy of Power of Attorney/Board resolution authorizing to act as P.E.Power of Attorney in the name of Zonal DirectorPower Of Attorney - FD
Copy of MOA/AOA/Partnership Deed/Proprietor's I.D. Proof Memorandum & Certificate of IncorporationMemorandum & COI - FHL,Memorandum & COI - FHTL
Nature of Work for which contract works are to be engaged/employed As per Annexure - B Given below
Form "V" issued by P.E. to each contract - Rule 21(2)Form Vform 5 prime facility sevice item
Notice of commencement/completion of contract work Rule 21(2)Form VI BForm VI Ghibelliance BT
Application in Form I - Rule 17(2)Application submitted for Renewal of Reg. CertificateRC Application BT
Agreement with each contractor along with rate &no. of worker for which contract has been givenValid Contracts & Extension of Contracts
Letter of extension of contract period issued to contractors, in case of renewal of licenceValid Contracts & Extension of Contracts
Affidavit by P.E. regarding compliance of Rule 25(2)(V) and that wages to contract worker are being paidSelf Declaration by Principal EmployerSelf Declaration by Principal Employer
Name and Designation of the person authorized under Rule Ms. Shubhra Kohli, Unit Head - Human Resources
Mobile : 9911129588
E-Mail ID : shubhra.saxena@fortishealthcare.com

Mr. Rajeev Kumar, Human Resources
Mobile : 8447738045
E-Mail ID : rajeev.kumar2@fortishealthcare.com
Challan of Registration Fees(G.A.R-7)N.AN.A
Registration Certificate No. under C L R A Act, 1970CLA/PE/09/NW/2012RC FY 18-19
Registration Number/Certificate under the Companies Act,1956Memorandum & Certificate of IncorporationMemorandum & COI - FHL,Memorandum & COI - FHTL
Registration Number/Certificate under the Delhi Shops & Establishment Act,1954/Factories Act,1948Certificate under Shops & Commercial Establishment ActCertificate under Shops & Commercial Establishment Act
Copy of application for AmendmentApplication submitted for Renewal of Reg. CertificateRC Application BT
Annual Return-Rule 82(2)Annual Returns CLA Annual return
ANNEXURE-B
Name & address of the contractor establishmentWebsite LinkNature of work of contractMax. No. of workers
proposed to be employed
Period of contract
Swift Securitas Pvt Ltd, 2, Rajdhani Enclave, Near Rani Bagh,Pitampura, New Delhi-110034
Contact Person: Mr. Anil Mago
Mobile : 9717997174
E-Mail: anil.mago@swiftsecuritas.in
https://swiftsecuritas.in/Security services6001-Apr-2031-Mar-21
Atulya Helathcare (Mukul Sales Ltd), H. No. 3038, Sector 20D, Chandigarh, Punjab
Contact Person: Ms. Rasha Sharma
Mobile: 9958390920
E-Mail : radha.sharma@atulaya.com
http://mukulsales.com/login.aspx Radiology Services 1801-Apr-2031-Mar-21



For more details/queries, please write to us at reachus@fortishealthcare.com

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