[See sub-rule (2) of rule 3]
Notice of Change
Name and address of
the Establishment,
Take notice that following changes have taken place with effect from …………………….. in the particulars furnished by me in notice dated ………………….. on Form A '.
Name.
Address.
Name of the employer.
Nature of business
Place Signature of the employer
Date with name and designation
To
The Controlling Authority
……………………………
……………………………
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