ODISHA BUILDING AND OTHER CONSTRUCTION WORKERS' WELFARE BOARD,

BHUBANESWAR.
CONSTRUCTION WORKER IDENTITY CARD
FORM XXVIII
[See Rule 266(1)]

Registration Number : ODBLS002007295 Date of Registration : 27-02-2024

Name : LAXMIDHAR MOHANTY

Sex : Male

Date of Birth : 10-07-1983

Marital Status : Married

Father’s Name : Purna chandra Mohanty

Spouse Name : MADHUCHHANDA MOHANTY

Permanent Address : Badanuapur BALASORE Nilagiri Bank Details : Acc no:36531618563

Nilagiri (NAC) - Ward No.1 756003 Bank name: STATE BANK OF INDIA
Branch name: BALASORE Proof
road
IFSC: SBIN0012047

Present Address : Badanuapur BALASORE Nilagiri Religion : Hindu

Nilagiri (NAC) - Ward No.1 756003

Category : General

Physically Challenged : NO Nature of job : Helper to Mason(Mistri)

NFSA/SFSA Card No : 02090812393

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Interstate migrant worker : NO Signature Not Verified
Document Digitally Signed
Signature of the worker : Date: 2024.02.28 07:35:38 IST
Reason: Registration
Location: BALASORE
Place : BALASORE

Date : 27 Feb 2024

Registration Valid Upto : 26-02-2027 JOSHABANTA AMAT

Annual Contribution last : Registering Officer

paid on Office of the Assistant Labour
Officer,Nilgiri, Balasore

Note:- i This is a digitally signed electronically generated certificate and therefore needs no ink-signed signature.
ii This certificate is issued as per section 4, 5 & 6 of IT Act, 2000 and its subsequent amendments in 2008.
iii For verification, visit https://nirmanshramik.odisha.gov.in.
iv Tampering of this certificate will attract penal action.
v The card holder may download new updated identity card from his/ her own login dashboard in the onlineportal on expiry of validity period
subject to regular payment of Annual Contribution for renewal.