Contract Labour (Regulation & Abolition) Central Rules

FORM XV
See Rule 77

Service Certificate

Name and address of Contractor

Nature and location of work

Name and address of the workman

Age or Date of Birth

Identification Marks
Father’s/Husband’s Name
Name and address of establishment in/under which contract is carried on

Name and address of Principal Employer

Sl. Total Period for Nature of work Rate of wages Remarks

No. which employed done (with particulars of
unit in case of
piece-work)
From To

1 2 3 4 5 6

Signature