FORM XIV

[See Rule 76]

Employment Card

Name and M/s. Name and HPCL Terminal

address of address of
Contractor Establishment
in / under
which
contract is
carried on

Nature of Name and

work and address of
location of Principal
work Employer

1. Name of the workmen : Shri

2. S. No. in the register of workmen :

employed

3. Nature of employment / Designation :

4. Wage rate (with particulars of unit, in : Rs.

Case of piece-work)

5. Wage Period : Monthly

6. Tenure of employment : From to

7. Remarks

Signature of Contractor