Form-B REGISTER OF EMPLOYEES1. Serial No. ( Vide rules 48(3), 51, 77, and 77A(2) of Mines Rules, 1995 ) 2 3 4 5 6 Name and surname of the employee Father's or Husband's name Age and Sex Age : 38 Sex : Male

No. and date of the certificate, if any, held, under the _________ __________ Mines Vocational Training Rules, 1966 a) Designation of the employee. Field Manager - Maintanence Material Mgmt b) Nature of employment (whether above or below ground, and if above ground whether in open cast Group Gathering Station(Above Ground) working or otherwise). Home address of the employee, giving Village, Thana, Post office and District.

7

8 9 10 11

Date of commencement of employment. Date of first appointment, with the present owner. Date of termination or leaving of employment. In case of an adolescent reference to certificate of fitness granted under section 40.

_________

_________

12 13

Mark of identification on the body. Mole on Left hand Name, address, relationship of person to be informed in case of accident / emergency.

14

Token number and other particulars by which the employee may be identified.

15

Passport size photograph of the person employed.

16 Signature or thumb impression of the employee

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Remarks :- Blood Group:-

"O" Positive

[Note :- As per Rule 77 separate page is to be allotted for each person employed].

Signature of Manager.