The Arunachal Pradesh Occupational Safety, Health and Working Conditions Rules, 2022
Form XV
Official text
Open in the official PDF (p. 221)
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(Under Rule-42)
EXPERIENCE CERTIFICATE OF CONTRACT EMPLOYEE
To whom so ever concerned
1. Name and address of contractor/employer*:
2. LIN/PAN No. of the contractor/employer *:
3. Email Id of the contractor /employer*:
4. Mobile No. of the contractor/employer *:
5. Nature and location of work:
6. Name of Principal Employer*:
7. LIN/PAN No. of the Principal Employer:*
8. Email Id of the Principal Employer :*
9. Mobile No. of the Principal Employer:*
10. Name of the worker*:
11. UAN / Aadhaar No. of worker :
12. Mobile No. of worker :
13. Serial Number in the Employees Register:
14. Registration number, date and name of the Board if the Building and Other Construction Worker
is registered as a beneficiary:
15. Period of Employment:
16. Designation of the worker:
Seal and Signature of Contractor
*Please strike off whichever is not applicable.