Self-Certificate Regarding Employment

(To be issued by Construction Labour)

This is to certify that I (Name of Construction

Worker)____________________________________________________S/o-D/o-
W/o__________________________________________Address______________________________________
___________________________________________________________________________________ am
working as ___________________________(nature of work) which comes under the category of construction
worker.

I have worked more than 90 days in last one year with M/s.
/At_____________________________________________________(Post) and at other sites

Above certificate is being issued by me under Rule 266(3) of DBOCWW (Rule and Service conditions for
Employment) Rules, 2002 and I am completely responsible for its genuine ness.

Signature

Date Name:

___________________________________________________________________________
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¼ स्वयं }kjk½

मैं ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ (नाम)

iq=@iq=h@iRuh ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- irk ----------
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------- यह सत्यापित करता हूँ पक मैं ---------------------------------------------------------------------------------
---------------(कायय ) का काम करता हूँ जोपक निर्ायण कायय के अंतर्गत आता है
मैंने fiNys ,d o’kZ esa 90 ¼uCcs½ fnuksa ls vf/kd lfUuekZ.k Jfed ds :i esa
___________________________________________________________________________
__________ (कॉन्ट्रै क्टर का नाम , पता ) व अन्ट्य जगहों पर dke fd;k gSaA

उपरोक्त सत्यापि धारा 266 (3) डी बी ओ सी डब्ल्यू डब्ल्यु नियर्, 2002 के अंतर्यत र्ैं दे रहा हूँ और इसकी
सत्यता के निए परू ी तरह से र्ैं निम्र्ेदार हूँ l

gLrk{kj %
fnukad uke