FORM B
See rules 48(3), 51, 77 and 77A(2)
 
1. Serial No.
2. Name and surname of the employee.
3. Father’s or Husband’s name.
4. Age and sex.
5. No. and date of the certificate, if any, held under the Mines Vocational Training Rules, 1966.
6.         (a) Designation of the employee.
(b) Nature of employment (whether above or below ground, and if above ground whether in open cast working or otherwise).
(c) Whether employment is permanent or temporary or casual.
7. Home Address of the employee, giving Village, Thana, Post Office and District.
8. Date of commencement of employment.
9. Date of first appointment, with the present owner.
10. Date of termination or leaving of employment.
11. In case of adolescent reference to certificate of fitness granted under section 40.
12. Mark of identification on the body.
13. Name, address, relationship of person to be informed in case of accident/emergency.
14. Token number and other particulars by which the employee may be identified.
15. Passport size photograph of the person employed. Photo
16. Signature or Thumb impression of the employee.
17. Remarks
Signature of Manager.