FORM No.

11
[See Rule 112]
REGISTER OF ADULT WORKERS
For the year July/Month: Dec-2015 to Dec-2015
Certificate of adolescent

Sl.

Name and Residential address of

the worker

Fathers Name

Nature of work and Department

Symbol

Relay assigned
and date of
effect

No. of
Certificate and
date

Token number
giving
reference to
the certificate
7

Certificate of adolescent

Sl.

Name and Residential address of

the worker

Sl.
1

Name and Residential address of

the worker
2

Sl.
1

Name and Residential address of

the worker
2

Fathers Name

Nature of work and Department

Symbol

Relay assigned
and date of
effect

No. of
Certificate and
date

Fathers Name
3

Nature of work and Department

Symbol
4

Relay assigned
and date of
effect
5

Fathers Name
3

Nature of work and Department

Symbol
4

Relay assigned
and date of
effect
5

Token number
giving
reference to
the certificate
7

Certificate of adolescent
Token number
giving
reference to
No. of
the certificate
Certificate and
date
6
7
Certificate of adolescent
Token number
giving
reference to
No. of
the certificate
Certificate and
date
6
7

Date of first
Employment in
the Factory

Remarks

Date of first
Employment in
the Factory

Remarks

Date of first
Employment in
the Factory

Remarks

Date of first
Employment in
the Factory

Remarks