Contact Labour (Regulation and Abolition) Act, 1970
FORM XV : SERVICE CERTIFICATE
[Rule 77]
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Name and address of_________________
_________________________ contractor
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Name and address of establishment of
in/under which contract is carried on __________________________
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Name and location of work____________
_______________________
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Name and address of
the __________________________________
workman ___________________
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Name and address of principal
employer________________________
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Age or Date of Birth
_____________________________
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Identification
marks______________________________
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Father's /Husband's name
________________________
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Sl. No.
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Total period for which employed
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Nature of work done
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Rate of wages(with particulars of
unit in case of piece-work)
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Remarks
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From
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To
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1
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2
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3
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4
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5
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6
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Signature of contractor
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