(Furnish the Certificate "F" given overleaf)

Notes.-(1) Such other documents, certificates, etc., as may be required by the sanctioning authority are also required to be furnished, through the establishment.

(2)

In case no intimation is received within a month please write to the R.P.F.C./Officer-in-Charge of sub-regional office through the establishment.

Certificate-A (Refer: Instructions SI. No. 6)

Certified that no compensation was paid to the member Sri/Smt/................ for the period of lock-out/closure.

Signature of the Employer/Authorised officer with date and seal

Certificate-B (Refer: Instructions SI. No. 7)

Certified that member Sri/Smt ........................................... has not received his/wages for a continuous period of two months or more, i.e., from ...................................... to...................

Signature of the Employer/Authorised Officer with date and seal

Certificate-C (Refer: Instructions Sl. No. 8)

Certified that—

(i) The member Sri/Smt ........................has/had been granted leave for a period of ................. from.............. to...................

(ii) The ESI facilities/cash benefits are not actually available to the member/the member has ceased to be eligible for cash benefits under ESI certificate from ESI enclosed.

(i) is suffering from T.B./Leprosy/Paralysis/Cancer/Mental derangement/Heart ailment.

(ii) is suffering from .............................. (disease) for which a major surgical operation and hospitalisation for a period of ..................... days from .......................

(iii) is suffering from ........................... and hospitalisation for a period ............ days from ...................... to................ had or has become necessary.