LIST OF AFFECTED WORKERS

Names of Affected Contact Address Sex Age Educational Occupation/Skills Salary

Workers Attainment

1._______________________ ______________________ ____ _____ ______________________ _________________ ___________

2._______________________ ______________________ ____ _____ ______________________ _________________ ___________
3._______________________ ______________________ ____ _____ ______________________ _________________ ___________
4._______________________ ______________________ ____ _____ ______________________ _________________ ___________
5._______________________ ______________________ ____ _____ ______________________ _________________ ___________
6._______________________ ______________________ ____ _____ ______________________ _________________ ___________
7._______________________ ______________________ ____ _____ ______________________ _________________ ___________
8._______________________ ______________________ ____ _____ ______________________ _________________ ___________
9._______________________ ______________________ ____ _____ ______________________ _________________ ___________
10.______________________ ______________________ ____ _____ ______________________ _________________ ___________
11.______________________ ______________________ ____ _____ ______________________ _________________ ___________
12.______________________ ______________________ ____ _____ ______________________ _________________ ___________
13.______________________ ______________________ ____ _____ ______________________ _________________ ___________
14.______________________ ______________________ ____ _____ ______________________ _________________ ___________
15.______________________ ______________________ ____ _____ ______________________ _________________ ___________

I hereby certify that the information is substantially accurate.

Signature____________________________________ Telephone Numbers_______________________

Printed Name________________________________ Date______________________________________
Position______________________________________