FOR SECURITY GATE PASS - New Permanent Address, Local Address, Panipat

PERSONAL PARTICULAR PERFORMA

(TEMPORARY/ PHOTO PASS)
MAIN CONTRACTOR - SUB- CONTRACTOR

Work / Job. Oder No. - Date:- PF Code No. ESIC Code No. Commencement of work -
Labour Licence No. PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted -
Valid Date:- Place of Issue - Place of Issue - Completion of work -

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

Safety S/o Radhakrishn Pandey Dadlana, Panipat,

1 Sumit Pandey Officer Male 15.05.2000 O+ Un Marrried Father Narahiya Siwan Bargaon Haryana
Bihar 841239

S/o Ram Bilas Ram Dadlana, Panipat,

2 Amarjeet Kumar Halper Male 01.01.1996 B+ Un Marrried Father mataryam Madhepur Bihar Haryana
844113

Civil S/p Ramdev Benga Ram Dadlana, Panipat,

3 Ram Sandeep Ramdev Engineer Male 11.01.1993 AB+ Married Wife agsara Rampur siwan Bihar Haryana
841234

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of Recommeding authority (EIC) of IOCL with rubber Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Stamp Stamp Stamp
FOR SECURITY GATE PASS - New Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA
(TEMPORARY/ PHOTO PASS)
MAIN CONTRACTOR - SUB- CONTRACTOR

Work / Job. Oder No. - Date:- PF Code No. ESIC Code No. Commencement of work -
Labour Licence No.
PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted -
Valid Date:- Place of Issue - Place of Issue - Completion of work -

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

S/o Bindalal Pandit 70

1 Parminder Kumar Billing Engg Male 11.06.1991 O+ Married Wife sector -21 Mehashpur Dadlana, Panipat,
Panchkula Haryana 134116 Haryana

S/o Mahesh Ram

2 Radheshyam Kumar Barbender Male 17.09.1990 AB+ Married Wife Songadhava Dularpur Dadlana, Panipat,
Songharwa Bihar 841425 Haryana

S/o Sudama Ram

Songarhwa Dularpur Dadlana, Panipat,
3 Sunil Kumar Carpenter Male 05.01.1985 O+ Married Wife Gopalganj Songharwa Bihar Haryana
841425

4 Manoj Ram Barbender Male 13.01.1989 O+ Married Wife S/o Ram Deni Ram Dularpur Dadlana, Panipat,
Gopalganj Bihar 841425 Haryana

S/o Mehendra sahani

5 Gagan Kumar Barbender Male 01.01.1994 O+ Married Wife Raghopur Mustafapur Dadlana, Panipat,
Muzaffarpur Bihar 842004 Haryana

S/o Sunendra Ram Dadlana, Panipat,

6 Anil kumar Ram Barbender Male 01.01.1997 B+ Married Wife Mahamadpur Mahamda Haryana
Muzaffapur Bihar 843111

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of Recommeding authority (EIC) of IOCL with rubber Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

S/o Surendra Sahani Ward

7 Pintu Kumar Barbender Male 01.01.2004 B+ Un married Father No 8 Wattganj Pipra Chakia Dadlana, Panipat,
Pipra Bihar 845429 Haryana

S/o Aklu Ram Songadhava

8 Raju Kumar Halper Male 17.05.1999 O+ Un married Father Dularpur Songharwa Dadlana, Panipat,
Gopalganj Bihar 841425 Haryana

10

11

12

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of Recommeding authority (EIC) of IOCL with rubber Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

S/o .Bhadae Paswan

1 Umesh Paswan Barbender Male 01.01.1992 A+ Un married Father Ramgarh, Mahuawa, East Dadlana, Panipat,
Champaran Pipra Factory Haryana
Bihar 845429

S/o Sukhal Paswan

2 Kishun Paswan Halper Male 19.09.1975 B+ Married Wife Parsauni Kisun, East Dadlana, Panipat,
Champaran , Presauni Haryana
Kishun Bihar 845416

S/o. Harendra Sah

Basantpura, Thana Dadlana, Panipat,
3 Anil Sah Halper Male 10.11.1994 A+ Un married Father Sahebganj, Basantpur, Haryana
Chainpur Muzaffarpur
Bihar-843125

S/o. Shivaji Prasad Dadlana, Panipat,

4 Ravi Kumar Carpenter Male 15.09.1996 B+ Un married Father Kawalpur , Turkouliya, East
Champaran , Bihar-845437 Haryana

S/o. Sikindra Sahani

5 Sanoj Kumar Halper Male 01.01.1999 A+ Un married Father Hussepur Nayatoia, Dadlana, Panipat,
Sahebganj Muzaffarpur Haryana
Bihar- 843125

S/o. Jaymangal Das Dadlana, Panipat,

6 Raju Kumar Das Carpenter Male 02.05.1992 B+ Un married Father Ramgarh, Mahuawa, Purba Haryana
Champaran Bihar-845429

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of Recommeding authority (EIC) of IOCL with rubber Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

S/o. Bhulan Sah Ward no.

7 Kamlesh Kumar Carpenter Male 01.01.1999 B+ Un married Father 14, Kawalpur , Turkaulia, Dadlana, Panipat,
East Champaran , Bihar- Haryana
845437

S/o. Rajendra Prasad

8 Dharmendra Kumar Halper Male 01.01.1991 A+ Married Wife Kawalpur , Turkauliya, East Dadlana, Panipat,
Champaran , Bihar-845437 Haryana

S/o Bahadur Paswan

ramgarh mhuawa tola Dadlana, Panipat,
9 Sikindar Paswan Barbender Male 01.01.1990 O+ Married Wife waganj ramgah mahuawa Haryana
east champaran pipra bihar

10

11

12

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of Recommeding authority (EIC) of IOCL with rubber Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

S/o Ramdev Ram Baidhana

1 Shivchandra Ram Carpenter Male 01.01.1989 O+ Married Wife Cut Mark on Left thpur urf khanpur Mirzapur Dadlana, Panipat,
Hand Bihar Haryana

S/o Vatoran Paswan at -

2 Bhola Paswan Halper Male 01.01.1970 B+ Married Wife Cut Mark on Left post Paharpur Lakhminia Dadlana, Panipat,
Leg Balia Bihar 851211 Haryana

Cut Mark on Left S/o Om Prakash Rajput Dadlana, Panipat,

3 Bablu Fitter Male 20.05.2002 B+ Un Married Mother Hand gram kolar Huaur Bhopal Haryana
Madhya Pradesh 462042

S/o Nandu Gond gram

Cut mark on Right chainpur Dadlana, Panipat,
4 Girish Gond Carpenter Male 01.01.1975 O+ Married Wife achal sonbarsa
Hand jagdishpur Gopalganj Bihar Haryana

5 Vir Bhan Carpenter Male 03.07.1990 A+ Married Wife Cut Mark on Left S/o Balwant 30 kutana 26 Dadlana, Panipat,
Hand Karnal Haryana 132040 Haryana

Cut mark on Right S/o Rajesh Kumar Village Dadlana, Panipat,

6 Sawan Fitter Male 18.12.1994 A+ Married Wife Hand Kutana Karnal Haryana Haryana
132040

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of Recommeding authority (EIC) of IOCL with rubber Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

S/o Karmbir House no 325

7 Vikram Singh Halper Male 28.08.1999 O+ Married Wife Cut Mark on Left ward no 01 pacca khera Dadlana, Panipat,
Knee karnal Haryana 132036 Haryana

S/o Chandr Bali Sharma

8 Lalbabu Sharma Carpenter Male 01.01.1985 O+ Married Wife Cut mark on Right Chainpur bihar Gopalganj Dadlana, Panipat,
Hand Bihar Haryana

10

11

12

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of Recommeding authority (EIC) of IOCL with rubber Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Commencement of work - 16.08.2022
Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No.
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
N0. of Max. Workers Permitted - 1000
Description of work , Location :P25 Completion of work - 15.05.2025
Valid Date:- 20.10.2022 Place of Issue - Place of Issue -

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B.
Group
Marital Status Nominee Photo
Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

1 Ravi Shankar Kumar Sup Male 15.04.1994 B+ Married Wife Cut Mark on Left S/o Rajdev Yadav Kamata Dadlana, Panipat, Haryana
Knee danka arwal Bihar 804428

2 Vinay Kumar Fitter Male 08.08.1998 A+ Married Wife cut mark on Right S/o Lallan Bhimpatti Patti Dadlana, Panipat, Haryana
Hand Uttar Pradesh 277401

3 Ravi Kumar Sup Male 16.08.1989 O+ Married Wife Cut Mark on Left S/o Ramesh Kumar 240 Dadlana, Panipat, Haryana
Hand Begampur Karnal Haryana

S/o Sigasan Giri Sararpali

4 Hari Shanker Giri Helper Male 16.01.1978 A+ Married Wife cut mark on Right
Sagarpli Uttar Pradesh Dadlana, Panipat, Haryana
Hand
277506

S/o Shivshankar Giri

5 Shivji Giri Helper Male 01.01.1997 B+ Married Wife Cut Mark on Left
Sagarpli Rasra Ballia Uttar Dadlana, Panipat, Haryana
Knee
Pradesh 277506

6 Dashrath Ram Carpenter Male 01.01.1990 B+ Married Wife Strech mark on S/o Bhuneswar ram Hundra Dadlana, Panipat, Haryana
neek Jharkhand 829220

S/o Hari Singh House no

7 Rajkumar Helper Male 15.06.1971 O+ Married Wife Strech mark on
383 Block -0 Madlauda Dadlana, Panipat, Haryana
neek
Panipat Haryana 132140

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of Recommeding authority (EIC) of IOCL with rubber Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Stamp Stamp Stamp
FOR SECURITY GATE PASS - New
PERSONAL PARTICULAR PERFORMA
(TEMPORARY/ PHOTO PASS)
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022

Description of work , Location :P25

Sr. No. Name Of Worker Desig. Sex D.O.B.

Ravi Kumar Helper Male 16.08.1989

2 Shivji Giri Helper Male 01.01.1997

3 Ravi Kumar Sup Male 16.08.1989

 4 Hari Shanker Giri Helper Male 16.01.1978

5 Shivji Giri Helper Male 01.01.1997

Any special requirement refarding working timing From ……………………….……….. Hrs To

Confirming the above information carting to the best my knowledge and I will person

Sign of Recommeding authority (EIC) of IOCL with rubber

Stamp
6/16/1905
 L&T ENERGY - HYDROCARBON Perma
Knowkdge City Gate -01 West + Block -1 A
GURJRAT (IND
UB- CONTRACTOR BANSAL INFRATECH SYNERGIES

Labour Licence No. CLRA/ALCC

KARNAL/2022/L-346
N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022

Blood Marital Status Nominee Photo

Group

O+ Married Wife

B+ Married Wife

O+ Married Wife
 A+ Married Wife

B+ Married Wife

…….……….. Hrs To……………………..………. Hrs

and I will personally be responsible for the conduct and behavior above person.

Sign of main Contractor / Firm with rubb

Stamp
6/16/1905
 HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address,
te -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REF

PF Code No. ESIC Code No.

PBCHD1389891000 17000607710001009
orkers Permitted - 1000
Place of Issue - Place of Issue -

Identification Permanent Address with Local Address with Father

Mark Father / Husband Name / Husband Name

Cut Mark on Left S/o Ramesh Kumar 240 Dadlana, Panipat,

Knee Begampur Karnal Haryana Haryana

S/o Shivshankar Giri

Cut Mark on Left Sagarpli Rasra Ballia Uttar Dadlana, Panipat,
Knee Haryana
Pradesh 277506

Cut Mark on Left S/o Ramesh Kumar 240 Dadlana, Panipat,

Hand Begampur Karnal Haryana Haryana
 S/o Sigasan Giri Sararpali
cut mark on Right Dadlana, Panipat,
Hand Sagarpli Uttar Pradesh Haryana
277506

S/o Shivshankar Giri

Cut Mark on Left Sagarpli Rasra Ballia Uttar Dadlana, Panipat,
Knee Haryana
Pradesh 277506

ve person.

tractor / Firm with rubber Sign of Sub Contractor / Firm with

Stamp Stamp
 Local Address, Panipat
H PROJECT IOCL REFINERY PANIPAT 132140

Commencement of work - 16.08.2022

Completion of work - 15.05.2025

Signature Thumb
Impression GATE PASS NO.
tractor / Firm with rubber
Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

V.P.O. DHARMPUR V.P.O. DADLANA DISTT.

1 RAKEH RAM HELPER M 01.01.1988 B+ve MARRIED WIFE Cut Mark on Right NARAYAN TEHAL PANIPAT HARYANA
Hand MUZAFFARPUR RAMPUR 132140
BIHAR 843117

V.P.O. DHARMPUR V.P.O. DADLANA DISTT.

2 RAJA BABU HELPER M 01.01.2001 B+ve Un MARRIED MOTHER STRECH ON HECK NARAYAN TEHAL PANIPAT HARYANA
MUZAFFARPUR RAMPUR 132140
BIHAR 843117

Cut Mark on Right V.P.O. PARSAUNI KISUN V.P.O. DADLANA DISTT.

3 RANJEET BARBINDER M 15.04.1980 B+ve MARRIED FATHER Hand EAST CHAMPARN BIHAR PANIPAT HARYANA
845416 132140

Cut Mark on Left V.P.O. PARSAUNI KISUN V.P.O. DADLANA DISTT.

4 AJIT KUMAR CARPENTER M 01.10.1984 B+ve MARRIED FATHER EAST CHAMPARN BIHAR PANIPAT HARYANA
Hand 845416 132140

V.P.O. WARD NO. 8 V.P.O. DADLANA DISTT.

5 BIPAT KUMAR HELPER M 01.01.1976 B+ve MARRIED FATHER Cut Mark on Right DIGHALBANK PADAMPUR PANIPAT HARYANA
Hand KISHANGANJ BIHAR 855108 132140

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of Recommeding authority (EIC) of IOCL with rubber Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

V.P.O. DHARMPUR V.P.O. DADLANA DISTT.

1 RAKEH RAM HELPER M 01.01.1988 B+ve MARRIED WIFE Cut Mark on Right NARAYAN TEHAL PANIPAT HARYANA
Hand MUZAFFARPUR RAMPUR 132140
BIHAR 843117

V.P.O. PARSAUNI KISUN V.P.O. DADLANA DISTT.

2 RANJEET BARBINDER M 15.04.1980 B+ve MARRIED FATHER Cut Mark on Right EAST CHAMPARN BIHAR PANIPAT HARYANA
Hand 845416 132140

Cut Mark on Left V.P.O. PARSAUNI KISUN V.P.O. DADLANA DISTT.

3 AJIT KUMAR CARPENTER M 01.10.1984 B+ve MARRIED FATHER Hand EAST CHAMPARN BIHAR PANIPAT HARYANA
845416 132140

V.P.O. WARD NO. 8

Cut Mark on Right DIGHALBANK V.P.O. DADLANA DISTT.
4 BIPAT KUMAR HELPER M 01.01.1976 B+ve MARRIED FATHER PADAMPUR PANIPAT HARYANA
Hand KISHANGANJ BIHAR 855108 132140

V.P.O. WARD NO. 9 V.P.O. DADLANA DISTT.

5 GANESH MURMU BARBINDER M 01.01.2002 AB- MARRIED WIFE Cut Mark on Right DIGHALBANK PADAMPUR PANIPAT HARYANA
Hand KISHANGANJ BIHAR 855108 132140

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Sign of Recommeding authority (EIC) of IOCL with rubber Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

V.P.O. PARSAUNI KISUN V.P.O. DADLANA DISTT.

6 UPENDRA PASWAN BARBINDER M 14.06.1988 B+ve MARRIED WIFE Cut Mark on Left EAST CHAMPARN BIHAR PANIPAT HARYANA
Hand 845416 132140

Cut Mark on Right V.P.O. CHAINPUR KURHANI V.P.O. DADLANA DISTT.

7 DEVENDER RAM HELPER M 01.01.1987 B+ve MARRIED WIFE Hand MUZZAFARPUR BIHAR PANIPAT HARYANA
843119 132140

V.P.O. HONDAGA V.P.O. DADLANA DISTT.

8 SANDEEP RAM HELPER M 01.01.2000 B+ve UN MARRIED MOTHER Cut Mark on Left LOHARDAGA JHARKHAND PANIPAT HARYANA
Hand 835302 132140

V.P.O. HONDAGA V.P.O. DADLANA DISTT.

9 VIKAS KUMAR SITE ENGG. M 18.05.1994 B+ve UN MARRIED MOTHER Cut Mark on Right LOHARDAGA JHARKHAND PANIPAT HARYANA
Hand 835302 132140

Cut Mark on Right V.P.O. SONBARSA V.P.O. DADLANA DISTT.

10 VIJAY KUMAR YADAV CARPENTER M 15.07.1985 B+ MARRIED WIFE Hand GOPALGANJ BIHAR PANIPAT HARYANA
8441508 132140

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Sign of Recommeding authority (EIC) of IOCL with rubber Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

V.P.O. SONBARSA V.P.O. DADLANA DISTT.

11 VIJAY KUMAR YADAV CARPENTER M 15.07.1985 B+ MARRIED WIFE Cut Mark on Right GOPALGANJ BIHAR PANIPAT HARYANA
Hand 8441508 132140

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Sign of Recommeding authority (EIC) of IOCL with rubber Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

V.P.O. JEETGARH V.P.O. JEETGARH

1 SATBIR FITTER M 01.01.1974 AB+ MARRIED WIFE Cut Mark on Right SIKANDERPUR KABRI SIKANDERPUR KABRI
Hand PANIPAT HARYANA 132103 PANIPAT HARYANA
132103

V.P.O. Pabana Hassanpur V.P.O. Pabana Hassanpur

2 AJAY KUMAR CARPENTER M 02.11.1999 B- MARRIED WIFE Cut Mark on Left Balrangran Karnal Haryana Balrangran Karnal
Hand 132040 Haryana 132040

Cut Mark on Right V.P.O. SIKANDERPUR KABRI V.P.O. SIKANDERPUR

3 RAJESH KUMAR CARPENTER M 09.07.1985 A+ MARRIED WIFE Hand PANIPAT HARYANA 132103 KABRI PANIPAT HARYANA
132103

V.P.O. H.NO. 107 NEW

Un V.P.O. H.NO. 107 NEW
Cut Mark on Right BAHOLI BAHOLI PANIPAT
4 ABHISHEK HELPER M 21.11.2003 A- FATHER PANIPAT REFINERY
MARRIED Hand PANIPAT HARYANA 132140 REFINERY PANIPAT
HARYANA 132140

V.P.O. 876 JEETGARH V.P.O. 876 JEETGARH

5 RAJENDER BARBENDER M 01.01.1971 AB+ MARRIED FATHER Cut Mark on SIKANDERPUR KABRI SIKANDERPUR KABRI
FINGER PANIPAT HARYANA 132103 PANIPAT HARYANA
132103

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Sign of Recommeding authority (EIC) of IOCL with rubber Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

V.P.O. 133 JEETGARH V.P.O. 133 JEETGARH

6 SANDEEP HELPER M 01.01.1999 A- Un FATHER Cut Mark on Right SIKANDERPUR KABRI SIKANDERPUR KABRI
MARRIED Hand PANIPAT HARYANA 132103 PANIPAT HARYANA
132103

V.P.O. GARHI SIKANDER

V.P.O. GARHI SIKANDER PUR JEETGARH
7 ASHOK HELPER M 02.10.1991 O- MARRIED WIFE Cut Mark on Left PUR JEETGARH SIKANDERPUR KABRI
Hand SIKANDERPUR KABRI PANIPAT HARYANA
PANIPAT HARYANA 132103 132103

V.P.O. H.NO. 107 NEW

Cut Mark on Right V.P.O. H.NO. 107 NEW BAHOLI PANIPAT
8 RANDHIR FITTER M 01.01.1979 B+ MARRIED SON LEG BAHOLI PANIPAT REFINERY REFINERY PANIPAT
PANIPAT HARYANA 132140 HARYANA 132140

V.P.O. H.NO. 850 GARHI

9 SANJAY KUMAR HELPER M 16.08.1988 B+ MARRIED FATHER Cut Mark on Right V.P.O. H.NO. 850 GARHI
SIKANDER PUR KABRI SIKANDER PUR KABRI
Hand PANIPAT HARYANA 132103 PANIPAT HARYANA
132103

V.P.O. JEETGARH KABRI

10 PARVEEN HELPER M 20.05.1987 B+ MARRIED FATHER Cut Mark on Right V.P.O. JEETGARH KABRI PANIPAT HARYANA
Hand PANIPAT HARYANA 132103 132103

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Sign of Recommeding authority (EIC) of IOCL with rubber Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B.
Group
Marital Status Nominee Photo
Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

V.P.O. H.NO. 125 GARHI

V.P.O. H.NO. 125 GARHI SIKANDER JEETGARH
11 RAJU HELPER M 12.06.1994 B+ MARRIED FATHER Cut Mark on Right SIKANDER JEETGARH SIKANDERPUR KABRI
Hand SIKANDERPUR KABRI PANIPAT HARYANA
PANIPAT HARYANA 132103
132103

V.P.O. PABANA
V.P.O. PABANA HASANPUR HASANPUR BALRANGRAN
12 SHAMSHER CARPENTER M 04.01.1993 A+ MARRIED FATHER Cut MARK on FACE BALRANGRAN KARNAL
HARYANA 132040 KARNAL HARYANA
132040

V.P.O. PABANA
V.P.O. PABANA HASANPUR HASANPUR
Un BALRANGRAN
13 SHHESH PAL CARPENTER M 16.11.1998 B+ MARRIED FATHER Cut MARK on FACE BALRANGRAN KARNAL KARNAL HARYANA
HARYANA 132040
132040

V.P.O. JEETGARH GARHI V.P.O. JEETGARH GARHI

14 PARDEEP KUMAR HELPER M 11.12.2001 A+ Un FATHER Cut Mark on Right SIKANDERPUR PANIPAT SIKANDERPUR PANIPAT
MARRIED Hand
HARYANA 132103 HARYANA 132103

V.P.O. H.NO. 776

15 BAJINDER HELPER M 20.11.1981 O+ MARRIED WIFE A BLACK MOLE ON V.P.O. H.NO. 776 JEETGARH
GARHI SIKANDERPUR JEETGARH GARHI
RIGHT HAND SIKANDERPUR PANIPAT
PANIPAT HARYANA 132103 HARYANA 132103

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Sign of Recommeding authority (EIC) of IOCL with rubber Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B.
Group
Marital Status Nominee Photo
Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

V.P.O. PABANA HASANPUR V.P.O. PABANA

16 SANDEEP HELPER M 30.10.1998 B+ MARRIED FATHER Cut Mark on LEFT BALRANGRAN KARNAL HASANPUR BALRANGRAN
Hand HARYANA 132040 KARNAL HARYANA
132040

V.P.O. H.NO. 41
V.P.O. H.NO. 41 JEETGARH JEETGARH GARHI
17 PARVEEN KUMAR FITTER M 05.06.1986 B+ MARRIED WIFE Cut Mark on KNEE GARHI SIKANDERPUR
PANIPAT HARYANA 132103 SIKANDERPUR PANIPAT
HARYANA 132103

V.P.O. H.NO. 843 JEETGARH V.P.O. H.NO. 843

UN JEETGARH GARHI
18 MOHIT HELPER M 15.05.2002 A+ MARRIED FATHER Cut Mark on NOSE GARHI SIKANDERPUR SIKANDERPUR PANIPAT
PANIPAT HARYANA 132103
HARYANA 132103

V.P.O. JEETGARH GARHI V.P.O. H.NO. JEETGARH

19 VINOD HELPER M 20.12.1991 B+ MARRIED WIFE SMALL CUT ON SIKANDERPUR PANIPAT GARHI SIKANDERPUR
RIGHT HAND PANIPAT HARYANA
HARYANA 132103 132103

V.P.O. H.NO. JEETGARH

V.P.O. JEETGARH GARHI GARHI SIKANDERPUR
20 PARDEEP HELPER M 01.01.1992 A+ MARRIED FATHER CUN ON FORHEAD SIKANDERPUR PANIPAT
PANIPAT HARYANA
HARYANA 132103 132103

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Sign of Recommeding authority (EIC) of IOCL with rubber Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B.
Group
Marital Status Nominee Photo
Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

V.P.O. H.NO. 841

V.P.O. H.NO. 841 JEETGARH JEETGARH GARHI
21 RAMESH KUMAR FITTER M 02.08.1970 B+ MARRIED FATHER Cut Mark on KNEE GARHI SIKANDERPUR KABRI SIKANDERPUR KABRI
PANIPAT HARYANA 132103 PANIPAT HARYANA
132103

V.P.O. DHARMPUR
UN STRECH MARK ON NARAYAN TEHAL V.P.O. DADLANA DISTT.
22 RAJA BABU HELPER M 01.01.2001 B+ MOTHER PANIPAT HARYANA
MARRIED NECK MUZAFFARPUR RAMPUR 132140
BIHAR 843117

V.P.O. HENDEHAS KOTTAN V.P.O. DADLANA DISTT.

23 MAHENDRA ORAON FITTER M 01.01.1994 O+ MARRIED WIFE MOLE ON NOSE LATEHAR JHARKHAND PANIPAT HARYANA
829204 132140

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Sign of Recommeding authority (EIC) of IOCL with rubber Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B.
Group
Marital Status Nominee Photo
Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

V.P.O. PABANA HASANPUR V.P.O. PABANA

16 SANDEEP HELPER M 30.10.1998 B+ MARRIED FATHER Cut Mark on LEFT BALRANGRAN KARNAL HASANPUR BALRANGRAN
Hand HARYANA 132040 KARNAL HARYANA
132040

V.P.O. H.NO. 41
V.P.O. H.NO. 41 JEETGARH JEETGARH GARHI
17 PARVEEN KUMAR FITTER M 05.06.1986 B+ MARRIED WIFE Cut Mark on KNEE GARHI SIKANDERPUR SIKANDERPUR PANIPAT
PANIPAT HARYANA 132103 HARYANA 132103

V.P.O. H.NO. 843 JEETGARH V.P.O. H.NO. 843

18 MOHIT HELPER M 15.05.2002 A+ UN FATHER Cut Mark on NOSE GARHI SIKANDERPUR JEETGARH GARHI
MARRIED PANIPAT HARYANA 132103 SIKANDERPUR PANIPAT
HARYANA 132103

V.P.O. H.NO. JEETGARH

SMALL CUT ON V.P.O. JEETGARH GARHI GARHI SIKANDERPUR
19 VINOD HELPER M 20.12.1991 B+ MARRIED WIFE RIGHT HAND SIKANDERPUR PANIPAT PANIPAT HARYANA
HARYANA 132103 132103

V.P.O. JEETGARH GARHI V.P.O. H.NO. JEETGARH

20 PARDEEP HELPER M 01.01.1992 A+ MARRIED FATHER CUN ON FORHEAD SIKANDERPUR PANIPAT GARHI SIKANDERPUR
HARYANA 132103 PANIPAT HARYANA
132103

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Sign of Recommeding authority (EIC) of IOCL with rubber Stamp Stamp Stamp
FOR SECURITY GATE PASS - New L&T ENERGY - HYDROCARBON Permanent Add: L&T Limited L&T Permanent Address, Local Address, Panipat
PERSONAL PARTICULAR PERFORMA Knowkdge City Gate -01 West + Block -1 Ajwa NH -08, VADODRA - 390019
(TEMPORARY/ PHOTO PASS) GURJRAT (INDIA) L&T LTD IOCL RUCH PROJECT IOCL REFINERY PANIPAT 132140
MAIN CONTRACTOR - LARSEN & TOUBRO LIMITED SUB- CONTRACTOR BANSAL INFRATECH SYNERGIES
INDIA LTD.
Work / Job. Oder No. - 28121563 Date:- 09.09.2022 Labour Licence No. CLRA/ALCC PF Code No. ESIC Code No. Commencement of work - 16.08.2022
KARNAL/2022/L-346 PBCHD1389891000 17000607710001009
Description of work , Location :P25 N0. of Max. Workers Permitted - 1000
Valid Date:- 20.10.2022 Place of Issue - Place of Issue - Completion of work - 15.05.2025

Blood Identification Permanent Address with Local Address with Father Signature Thumb
Sr. No. Name Of Worker Desig. Sex D.O.B. Group Marital Status Nominee Photo Mark Father / Husband Name / Husband Name Impression GATE PASS NO.

V.P.O. H.NO. 841

V.P.O. H.NO. 841 JEETGARH JEETGARH GARHI
21 RAMESH KUMAR FITTER M 02.08.1970 B+ MARRIED FATHER Cut Mark on KNEE GARHI SIKANDERPUR KABRI SIKANDERPUR KABRI
PANIPAT HARYANA 132103 PANIPAT HARYANA
132103

V.P.O. DHARMPUR
UN STRECH MARK ON NARAYAN TEHAL V.P.O. DADLANA DISTT.
22 RAJA BABU HELPER M 01.01.2001 B+ MARRIED MOTHER NECK MUZAFFARPUR RAMPUR PANIPAT HARYANA
BIHAR 843117 132140

V.P.O. HENDEHAS KOTTAN V.P.O. DADLANA DISTT.

23 MAHENDRA ORAON FITTER M 01.01.1994 O+ MARRIED WIFE MOLE ON NOSE LATEHAR JHARKHAND PANIPAT HARYANA
829204 132140

Any special requirement refarding working timing From ……………………….……….. Hrs To……………………..………. Hrs

Confirming the above information carting to the best my knowledge and I will personally be responsible for the conduct and behavior above person.

Sign of main Contractor / Firm with rubber Sign of Sub Contractor / Firm with rubber
Sign of Recommeding authority (EIC) of IOCL with rubber Stamp Stamp Stamp