FORM -E

(See rule 41)
IDENTITY CARD

Sl. No ………………… Photo of the worker

Name of the factory/establishment/contractor:

Name of the worker:

Father/Husband’s name:

Address:

Age (Date of birth):

Token No.:

Place of work Establishment/Home.

Dispensary:

M.P.I.

Particulars of dependents:

Serial No. Name Age Relationship

1.
2.
3.
4.
5.
6.
7.
8.

Signature of worker; Signature of employer of factory
/establishment /contractor

Date of issue:

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