FORM XV

(See Rule 77)

Service certificate

Name and address of establishment in/under : L&T Construction, Heavy Civil lC,
Which contract on work carried on Mount Poonamallee Road,
Manapakkam, Chennai, Pin-600089

Name and address of Contractor : MARK OUTSOURCING

Trade Square, B Wing,
Opp, Orkay mills, Sakinaka,
Andheri (E) Munbai-400072

Name of location of work : Construction work of BMRCL, RT-03, Bangalore

Name and address of the principal employer : Bangalore Metro Rail Corporation
B.M.T.C Complex, 3rd Floor,
K.H. Road, Shanthinagar,
Bangalore-560027

Name and address of workman : Mr.ANKUR UPADHYAY

Sihauli jarayat Patti (V)
Kerakat (PO), Jaunpur (Dist)
Kerakat (Ps), Uttar Pradesh – 222142

Age and Date of birth : 24 Years, 02/04/1999

Identification Mark : A MOLE ON LEFT HAND

Father's/Husband's Name : Shishira Rout

Token Number : 7816

Total period of which employed : From 10/12/2019 to 05/05/2023

Nature of work done : ELECTRICAL ENGINEER

Rate of wages : Rs.866.00/- per day

Remarks : 1. Efficiency : Very good / Good / Satisfactory

2. Attendance : Regular / irregular

3. Conduct : Very good / Good / Satisfactory

Reason for leaving service : Resigned

E.P.F Account / UAN No. : UAN 101631924875

Signature of workman Authorized Signature

Date: