THE PUNJAB EMPLOYEES SOCIAL SECURITY INSTITUTION CERTIFICATE OF CONTRIBUTIONS WAGES AND EMPLOYMENT

Name of Secured Person______________________ Social Security Number

A

Ticket Number/Works Number/khatta etc.______________________________________

I certify that the above named person has been (1) continuously employed be me And paid contribution for at least 90/180 days during the last 6/12 months and the number of days worked by HIM or HER in each of the last 6/12 months was as under :-

MONTH 1 2 3

Number of Days MONTH 1 2 3

Number of Days

( ii ) The last date of work was ( iii ) The rate of wages last paid to HIM or HER was :-

Rs. Rupees

Per

( iv ) I further certify that the above named person was in my employment

___________________( date of accident or of on set of occupational disease ). ( v ) A report of the accident on Form B-3 HAS NOT been submitted. NO. of Employer

___________________ Employer’s Stamp

( Date )_________________( Signature )__________________ On behalf of Employer

WEST PAKISTAN EMPLOYEES SOCIAL SECURITY INSTITUTION

CERTIFICATE OF FITNESS TO RESUME WORK

A

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