F O R M - V
return of National and Festival Holidays Rules,1969
the year ___________
01. Name of the Industrial Establishment :
02. Name of the occupier :
03. Name of the Manager :
04. District :
05. Postal Address :
06. Total Person employed during the year : Men. Women. Young Person.
07. No.of person who were paid wages or the
National & Festival Holidays (Separate
Figure for each day may be furnished)
a) 26th January
b) 15th August
c) 2nd October
08. Total amount paid (Separate figure for
each day may furnished)
Certified that the information furnished above is correct to the best of my knowledge and belief.
Signature of the Employer.
Place_______________ Signature of the Employer.
Rule -21 (2) )
OF CERTIFICATE BY PRINCIPAL EMPLOYER.
Certified that I have engaged the applicant Sri___________
Aged.________ Son of _______________ At/- ________ P.O: ____________
Dist._________ bound by all the provision of the contract Labour (Regulation and Abolition)Act,1970 and the contract lab pour (Regulation and Abolition ) Rules,1975 in respect of the employment of contract labour by the applicant my establishment.
Place____________________ Signature of the Principal
Date.____________________ Employer (With seal)