Odisha Building & Other Construction Workers'

Welfare Board, Government Of Odisha.

Receipt Number : 2392005 FORM No. O.T.C. 5 Date : 17-03-2024

(See Subsidiary Rule 43)

RECEIPT FORM
OFFICE OF THE REGISTERING OFFICER
UNDER THE BUILDING & OTHER CONSTRUCTION WORKERS'
(R.E.& C.S) ACT, 1996-CUM-DISTRICT LABOUR OFFICER

Received From : NIRANJAN BARIK

Father's name/Spouse's name :

Present Address : RAINTRA RAINTRA, District: BALASORE,

Block: KHAIRA,

Permanent Address : RAINTRA RAINTRA, State: ODISHA, District:

BALASORE,

with letter/application 2392005 Date 17-03-2024 the sum of 50.0 (Rupees fifty only) of renewal
fees of beneficiary under Section 12 of the Building & other (R.E. & C.S) Act. 1996 and Rule
265(2) (iv) of Orissa Building Construction Workers' Welfare Cess Rules.

Note:
(i) This is an electronically generated receipt from the system, which doesn't require signature.