Name And Address of gghj

hgj
FORM XXI Name & Address of
Establishment/under Which
Contract is Carried On:
(See Rule 78(1) (a) (ii)
Name And Address of Principal hgjhj
Nature & Location of Work: ghj

Name Of Father's/Husband's Name Nature of Act/ Date Of Whether Name of person in Date on
Sl No. Wage Amount of Remarks
Workman Employement Omnision for Offence workman whose presence which fine
Periods and Fine imposed
/Designation whichfiine showed employee's Realised
Wages
cause explanation was
1 2 3 4 5 6 7 8 9 10 11 12

1 PEPLCNTEMP2 ddd r Machinary 2010-01-21 No gggg 2011-01-26 gjhgj

2 PEPLCNTEMP4 ffg dfgdf ddddddddd 2011-01-26 Yes rrr 2011-02-02 gjhgj