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    Vinod Kumar
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    32 views4 pages

    Form 13 & 16

    Uploaded by

    Vinod Kumar

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 4
    To LLOYD INSULATIONS (INDIA) LIMITED ENGINEERS & CONTRACTORS: ‘SPECIALIST IN : THERMAL-HYDRO-ACOUSTIC-INSULATION UNIT No, ‘AWSt, "MANI CASADONA", 11TH FLOOR, PLOT NO. IF/4 ACTION AREF, NEW TOWN, RAJARHAT, KOLKATA-700156 ‘@ : 033 6799 1616 /033 6799 1600, Fax : (033) 67991615 E-mail: Lioyd.kol@lloydinsulation.com, lloyd@cal2.vsnl.n GIN : U74210DL1877PLC008629, Did. 06.06.1977. GSTIN : 19AAACLO4S6E12M ‘Annexure ~ Xill Be 6 Wt pears pSince 1888 (Undertaking & list of Persons for Temporary Gate Pass on Contractor's Letter Head) ow jaleqiae The HR Department Vedanta Limited Lanjigarh, Kalahand Subject: (Undertaking for any lability while working through temporary gate p2s3) Dear Sic, Following are the employees/ workmen list, and we ascertain theic credentials, age & identity. We undertake to obey al the safety norms while executing the work and submit the proof of payment of wages & other benefits as per statutory provisions apalicable ta them. In case af any complaint on logat dues we will be lable and responsible for the payment as directed by Vedanta Limited or Statutory authority or court cof law. The liability if at any stage wil also be recoverable from us with regard to our employees/ workmen. We undertake to indemnify Vedanta Limited, Lanjigarh of any Habilty arising out of employee/workmen compensation an any other statutory labiity and wll be paid by us. List of the Work Force for Temporary Gate Pass ‘| Name ofthe | Father's/Husband’ | Age | Sex | Nome of No | Work force Name vilage ‘Skil | Designation vF No. ANIL | Calan “Ikumag| kom |?) i Sufeat Ghar mon Beery Reon aon aia 8 3 Pik Shar | Saner | Wen Kumar | | Ram 20) m| Dheveg| Bhagnian| “| Kurnas| moéRe |Q)} Z 3 heiPer, RY & Fe (+). 2s04{1-1-2@014-2-96) FR] 8 Fy helles Regards, 180 9001-2008, 1SO 14001-2004 & OHSAS 18001-2008 CERTIFIED Registered Office: Plot No.2, Pun) Sons Premises, Katka Industrial Area, New Delhi-110019 ea ‘Visit on : ww lloydinsilation.com / wwwloydinsulation.com ENERGY IS LIFE ‘SERVE IT IM@ LLOYD INSULATIONS (INDIA) LIMITED o ENGINEERS & CONTRACTORS SPEGIALIST IN cTHERMIAL-HYORO-ACOUSTIC-INSULATION UNITNO, 44WS4, "MAN! CASADONAT,141H FLOOR PLOT NO. 4, ACTION AREA, NEW TOWN, RAURRH, KOLKATA 700856 + ‘2093 6799 1616 / 032 6709 1600, ox: 059) 6799 1615 is E-mail: oyd.kol@iloydineulation.com YOus Gi; U7a240015977PLe008029, Did 08.06.1977 lGSTIN: Z9AAACLOABGEAZM toe Annexure ~ XIV (Undertaking on Medical Fitness & Responsibility towards untoward incident on Contractor's Letter Head) te oe: fajealar- The Head — HSE Vedanta Limited Lanjigarh, Kalahandi Sub: Undertaking on Medical Fitness and Responsibility towards untoward incident We hereby undertake that the persons {in the attached list for temporary pass) are medically fit for work. \We shall be held responsible for any untoward incident taking place during the execution of the work by the persons at site or any in-disciplinary action done by these person at the premises of Vedanta Limited, Lanijigarh. Yours Faithfully Authorized Signature of the Contractor with Seal Name: BaSucley Designation: Sele -=10 Bera Personal Declaration: | declare that I ain physicagh rk and I have no past heaith record which prevents/advise me not to work in any industry. | am agreeing with the above undertaking given by my employee. Name of the Persons Signature of the Persons Anél kumar ale ares OVO Svutece Ram seu ee Sharwoan Kumar re ell Dhivag Kumar ae | ‘ENERGY 1S LIFE 180 9001-2008, i$0 14001-2004 & OHSAS 18001-2009 CERTIFIED A Visit on : waruilloydinsulation.com / wuw.loydinsulation.com : Registered Office : Plot No. 2, Punj Sons Premises, Kalai Industral Area, New Delhi:110019 1 |e LLOYD INSULATIONS (INDIA) LIMITED —~ | ENGINEERS & CONTRACTORS ‘SPECIALIST IN : THERMAL-HYDRO-ACOUSTIC-INSULATION UNIT No. 11WS1, “MAN CASADONA”, 11TH FLOOR, PLOT NO. IiF/4 ACTION AREALI'F, NEW TOWN, RAJARHAT, KOLKATA-700156 . ‘@ : 033 6799 1616 / 033 6799 1600, Fax : (033) 67991615 HS E-mail : Lioyd.kol@loydinsulation.com, lioyd@cal2.vsnl.net.in (Undertaking & list of Persons for Temporary Gate Pass on Contractor's Letter Head) To Date: Joalae The epamen \qhoaie Vedant tite Langa alahand Subject: (Undertaking for any lability while working through temporary gate pass) Dear Sir, Following are the employees/ workmen list, and we ascertain their credentials, age & identity. We undertake ta obey al the safety norms while executing the work and submit the proof of payment of wages & other benefits as per statutory provisions apaicable to them. In case of ny complaint on legal dues we will be lable and responsible for the payment at directed by Vedanta Limited ar Statutory authority or court of law. The lability if t any stage will also be recoverable from us with regard to aur employees/warkmen. We undertake to indemnity Vedanta Limited Lanigarh of any habit arising out of amployae/workmen compeasation and any other statutory liabity an wil be paid by us, feta d List of the Work Force for Temporary Gate Pass 3] Namectihe | Fathers/rusband” | age | Sex] Name of | 008 ] Ski] Oesignation [PF No | Workforce | sName Village _| _NO. DILSHAQ Khur Shel Vy |Sak ALAm Adam |2)m a 1SHiv. (Maekchhy aan o| mia ‘Wana, Rod (MP) mT Ma /KISU | Vivag Thakiy ISLnUm * Kumag ki 21) | nage DAHA | DedaP ental ae i Kurae Row'des ao} ™ Yor muKEsH Benda Bak RAIL Roe Pir Wag pate ger). Oth.) 8-2. zat * |: 2601S-3-82111° 49-9 Regards, ( (Fat Name 8S or the Xl rized Person) (Name & Seal of the Establishment), Loved Ons, (Oi Ltd. 150 goot-2008, Iso 40012008 & OHSAS 18001-2008 CERTIFIED ‘wuvwiloydinsulation.com / wwwloydinsulation.com Registered Offce: Plt No Pur Sons Promices Kaka rasta res: New Dei-+10018 Poe! i (= +LLOYD INSULATIONS (INDIA) LIMITED fe ENGINEERS & CONTRACTORS ‘SPECIALIST IN : THERMAL-HYDRO-ACOUSTIC-INSULATION. UNIT NO. 44WS4, "MANI CASROONA’, 44TH FLOOR, PLOT NO. F/4, [ACTION AREAAI ‘F, NEW TOWN, RAUARHAT, KOLKATA-700156 + ‘ 0336799 1616 / 033 6799 1600, Fax: (033) 6799 1615, 90h Email: Noyd.kol@tlydinsuiation.com OLS CIN: U74210011977PLCODSE23, Did. 06.06.1977 | GSTIN: 1AAACLOABGEIZM ‘Since 1259 Annexure ~ XIV Hinmeneting on Medica! Mines» & Respunsibuity towards untoward incident on Contractor's Letter Head) To Ihe Head — HSE ee 1qlalar Vedanta Limited Lanjigarh, Kalahandi Sub: Undertaking on Medical fitness and Responsibility towards untoward incident We hereby undertake that the persons (in the attached list for temporary pass) are medically fit for work. \We shall be held responsible for any untoward incident taking place during the execution of the work by the persons at site or any in-disciplinary action dene by these person at the premises of Vedanta Limited, tanjigarh. Yours Faithfully ee Authorized Signature of the Contractor with Seal Boagxucley Rank Bevemtons See Personal Declaration: | declare that ! am phy wark and | have no past health record which prevents/advise me not to work in any industry. | am agreeing with the above undertaking given by my employee. Mame of the Persuio nature of the Persons “ . Wad de oe OD Delshaot Akan atte ® shev Kumar vy ——_—_—_ wut @ Késv nomay ieee eee st = @ Seharen KY Mmay ee ern © , a et ‘ENERGY 1S LIFE 's0 58 200804002004 avon seooaan8 CARTED

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