PROFORMA

1. STATE/UT:
2. DISTRICT/REGION:
3. MUNICIPALITY/COMMUNE:
4. NAME & ADDRESS OF THE EMPLOYER/FIRM & CONTACT NO. OF
FACTORY MANAGER
5. SECTOR:
6. FACILITIES PROVIDED:

DETAILS OF MIGRANT WORKERS EMPLOYED DIRECTLY

SI.No Name Date Gende Occupat Date of Mobile Present Last Native Bank Jandhan Bank Bank Ujjwala Aadhaar No. Remarks
(1) of r ion Recruit No Residential Residential District A/c A/c A/c No. Details (Y/N) (16) (17)
(2) Birt (4) (5) ment (7) Address in Address in & State (Y/N) (Y/N) (13) (IFS Code) (15)
h (6) Puducherry Home State (10) (11) (12) (14)
(3) (8) (9)