FORM ‘A’

[See rule 4(1)]

Year ___________________________ Place of work____________________________

Name and address of employer __________________________________________
Nature of work being done by the establishment
Sr. Name of Father’s Date of Permanent Date of
No. Child name birth address Joining
the establishment
1 2 3 4 5 6
Nature of Daily hours Intervals Wages Remarks
work on of work of rest paid
employed
7 8 9 10 11

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z