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Form – A


[See rule 16(1)]

Year.......................

Name and address of employer.............................. Place of work.......................................................... Nature of work being done by the establishment.....................................................................................

Sl No Name of Child Father’s Name Date of Birth Permanent Address Date of Joining the establishment Name of the work on which employed Daily hours of work Intervals of rest Wage paid Remarks

1 2 3 4 5 6 7 8 9 10 11