Employee's Compensation Rules, 1934

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SCHEDULE EMPLOYEE'S COMPENSATION Returns relating to period from 1st January 2011to 31st December 2011 Employee's Compensation

Rules, 1934 State District Town or Village Post Office Name of Establishment Name of work Average numbers employed per day Accident Number of cases of injuries in respect of which final compensation has been paid during the year * Adults Minors Place: Death Nil Nil Permanent disablement Nil Nil Temporary disablement Nil Nil Amount of compensation paid Permanent disablement Nil Nil Temporary disablement Nil Nil Number of cases of diseases in respect of which final compensation has been paid during the year Nature of disease Nil Nil Death Nil Nil Permanent disablement Nil Nil Temporary disablement Nil Nil Amount of compensation paid Permanent disablement Nil Nil Temporary disablement. Nil Nil For, .

Death Nil Nil

Death Nil Nil

Date: /01/2012

Authorised Signatory

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