Print this format on your Company letter head and Four copies are requiring.

To, Safety Dept. (CVBU)

Security Officer Work at Height Training Safety Training
Tata Motors, Pimpri
Safety Training done on 29/07/2022
& 09/08/2022

Kindly allow our employees to work in Tata Motors Premises, for the Executing Agency mentioned below in A/B/C/G Shifts. These employees will work
only for Purchase Order(s) / Purchase Requisition raised on us (No. 2560045007 dated 05.05.2022 valid up to 31.03.2023 ).

Certified Surgeon Fitness

Contract Cell Executing Agency
Certiication

Sign : Sign : Sign :

H.G. Deshpande Name : Name :

Manager (LCC) Designation : Designation :

Period : From / /2022 To / /

Medical Period
S Dept/Shop
NAME Date of Birth Trade ESI No. PF No
No. Name Start
Month
1 Dhiraj Ankush Padule 28-12-1991 Engine Supervisor 3416110748 100932535743
Rameshwar Ashokrav
2 23-05-1992 Engine Supervisor - 101017884829
Deshmukh
3
4
5
6
7

P.F. Code No.:TH/THA/2059791/000/10079 ESI Code:100932535743

W.C. Policy No.14200034220400000004 W.C. Period : From 06/04/2022 to 05/04/2023

We will ensure that Safety rules & regulations are followed strictly & every employee will possess & display “Laminated Photo Identity
Card” while working in the TML premises.

Thanking you,

Yours faithfully

Health Service Dept.

Sign:
Name Signature
Designation Name :
 Safety Training

ining done on 29/07/2022

& 09/08/2022

These employees will work

).

ency

Fitness
Medical Period
for work
at
End Month height

aminated Photo Identity

ealth Service Dept.