FORM ‘A’ [See rule 4(1)] Year ___________________________ Place of work____________________________ Name and address of employer __________________________________________ Nature of work being done by the establishment Sr. Name of Father’s Date of Permanent Date of No. Child name birth address Joining the establishment 1 2 3 4 5 6 Nature of Daily hours Intervals Wages Remarks work on of work of rest paid employed 7 8 9 10 11
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