1. Name and address of the Establishment. 2. Name and designation of the Employer. 3. Number of persons employed. 4. Maximum number of persons employed on any day during the preceding twelve months with date. 5, Number of employees covered by the Act. 6. Nature of industry. 7. Whether seasonal. 8. Date of opening. 9. Details of Head Office/Branches. (a) Name and address of the head office.
Number of employees.
(b) Names and addresses of other branches in India.
.
I verify that the information furnished above is true to the best of my knowledge and belief.
Place Signature of the employer
Date with name and designation
To
The Controlling Authority
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