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FORM -12

Prescribed under Rule 107


Register of adult workers
Sl.
No

Name

Date
of
birth

Sex

Residen
tial
address

Fathers/
Husbands
name

Date of
appoint
ment

Group to which
worker belongs
Alphabet Nature
Assigned
of
work
8

Number
of relay
if
working
in
shifts
10

Adolescent if
certified as adult
Number
Number
& date of
under
certificate
section
of fitness
68
11
12

Remarks

13

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