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Form Xxi - Fines - Feb
Form Xxi - Fines - Feb
Name of the building Father’s / Designation/ Nature Wage period & Date & Amount of Purpose(s) for which advance
Sl.No.
worker Husband ‘s Name of employment Wages Payable advance given given
1 2 3 4 5 6 7
No. of installments by which advance to be Date & Amount of each installment Date of which last
Remarks
repaid repaid installment was repaid
8 9 10 11
Authorized Signatory