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FORM IX

[See rule 30(2)]


Haryana Building And Other Construction Workers Welfare Board
Return for the month of ……………… regarding the details of workers

Name and address of the Establishment

No. of workers as on the close of No. and Name(s) of workers(s) No. and Name worker(s) to be
Sr. No. previous month who service during the month registered No. of worker as on the current month

Place: Name and Signature of the Employer

Date: (Official Seal)

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