t
6.
i:r'1ld;i_ i'tr'^l J:;ii So:;i n:ndd iiJ di,d ';li.;. Nanre of the Member's o[ Eurplover'sFamily engagedin thc:cstal;lishnrent. irrdicatethe relationship with the emplol's1-.
6tJxr;5 ic.?J No. of Ernplolzees
sl.
\--------4li '"_
rsons li^I /'l'otal
7. 8.
ll a.
+-i"oe&gdEraaj Dcrclared Weeldv Holidav
&+ wdJ i-lJL,Je U\j{/jQ oJiJU
__pA
rir. /,Mell r ic. / \\rornerr so-:jrrl /
/ 7 a 1 t A
(' ,ru Ka lorli rn,
Receipt No.
Partictrlars o{'Fee Rernitted Challan / ReceiutNo. & Datc.
? : ' d r1' : r '
7. -iiSdri iit6u1i"d.-3 -iFils',J
Dr,SiEtrrl lq
an,t.fl)...
P A R T - B - A n yv R e
Rr:nr:',r,'al for the vears
ri. i:,!o ical. / Original Rcgll. Ccrtific-ate No.
;::. :":B; S.t3; -rrtll ;jrg_
Frorn l= Ff .J$ t/+
( |
.r". &I..F,[X.r.Zb)R
l l r I
i,i:o.d
fg
=iF.:F
r+*l*ta_"ay On* /mt I aa,=
(
Ward No. & Date of issuc / Circlc. w a r c t N o .. . . . . . . . . . . ./........ . s t . I(...t.t . . . . .c i r c l t : D . r qarl -' A' / PART- C -Any Change 10. -r"re irDc-ed 5g ica:Original Regn. CertificateNo.
I l. ;];-jF Ad.cd eEDrlD dg Warcl No. & Date of issue / Circle. io. le6d
------- n
Dtrscuptiorr aftt:rtlreClranqe Reasorrs ( Ncccssan lor Charrqc L)ot:r.rrnerrts shallbc crrckrserl ) 4
'l'lre
follon'illg changes have taken place in respcct oI-irrlbrnrat-iorrlrrrnisheclirr part - A.
S l .N o . tn Part - A
L
sl.
No
h'escnt Descnption
c
t)
:.i:u
:r--t:-U; :::IJl!:iJv:;:gwi::Jrrv J:----ni-.; :iu:1-.-J:i.1
u:-j =f::,it
5!l1i
t-:
=A
i,:;:a
gr::,;:.;l
:5la3il:".:
-a
j.ta!,=i
-:a=aa
: - 1 3I t / r l l j i r ' : .
i/;i:---.1-::t:-i:,a
f-.;:';r-.r.3..
L r r - t t l t : r ' [ ' : t rA t towlerlrtt' irrtrl t'r-r'ol.
Signcture oJEmploger / Authorised. signatory Designation & Seal.