I verify that the information furnished above is true to the best of my knowledge and belief.

Place ...........................

Date.............................

........................................................

Signature of the employer

with name and designation

To

The Controlling Authority

.............................................................

.............................................................

FORM 'B'

[See sub-rule (2) of rule 3]

Notice Of Change

Name and address of the Establishment,

Take notice that following changes have taken place with effect from ............................................. in the particulars furnished by me in notice dated ......................... on Form A'.

Name.

Address.

Name of the employer.

Nature of business

...................................................

Signature of the employer

with name and designation

Place ........................................

Date .............................................

To

The Controlling Authority

..............................................

..............................................

FORM 'C'

[See sub-rule (3) of rule 3]

Notice Of Closure

Take notice that it is intended to close down the establishment with effect from .................................. The other details are furnished below :