 |
Form 'B' |
 |
|
[See Rule 3(5)]
Statement of employers' contribution received by the Welfare Commissioner for six months ending on 30th June and 31st December respectively in the year ______________
| Class of Establishment |
Number of establishment |
Amount of employers' contribution received by the Welfare
Commissioner |
| 1 |
2 |
3 |
| |
|
Rs. |
| 1. |
Factories |
| 2. |
Motor Omni bus Service |
| 3. |
Shops |
| 4. |
Commercial establishments |
| 5. |
Residential hotel |
| 6. |
Restaurants |
| 7. |
Eating house |
| 8. |
Theatres |
| 9. |
Other place of Public amusement or entertainment ______________________________________ |
| |
TOTAL |
______________________________________ |
|
|
Signature of the
Welfare Commissioner
|
Local Services