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Labour Laws - Self Certification in SEZs

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PROFORMA No.II
 
(Self certification for IT based Industries, IT enabled services, Bio-Technology establishments, Exports Oriented Units and Units in Export Processing Zones under the Maternity Act, 1961 and Kerala Maternity Benefit Rules, 1964 for the Calendar year ……)
 
1
Name & address of the Factory/Establishment (with building No., Telephone Nos. & PIN Code)
  :
     
2
Registration/ Licence No. under the Factories Act, 1948 or the Kerala Shops and Commercial Establishments Act, 1960.
  :
     
3
Name (s) & address of the occupier (s) with residential address (es) (please specify the Telephone No.)
  :
     
4
Nature of service/commercial/industrial/manufacturing process carried on
  :
     
5 Total number of workers employed   :
     
  a)   Permanent  
            Male  
            Female  
            Total  
     
  b)   Temporary  
            Male  
            Female  
            Total  
     
  b)   Others if any (Specify)  
            Male  
            Female  
            Total  
     
     
DECLARATION
 
All the information furnished above are true and correct to the best of my/our knowledge, belief and information.
 
Signature of Employer Signature of Manager
Name: Name:
Designation: Designation:
Date: Date:
   
Office Seal: Office Seal:
   
   
CERTIFICATE
   
1. Certified that I/ We have complied am/ are complying with all the statutory requirements under the Maternity Benefit Act, 1961 and the Kerala Maternity Benefit Rules, 1964 to the extent applicable to the Establishment.
 
2. I/We am/are the authorized person/s to issue this certificate and this is issued with full knowledge of the legal liabilities under this Act and Rules. I am/we are jointly and severally liable for any information found incorrect subsequently and liable for prosecution under this Act and Rules made there under.
 
 
Signature of Employer Signature of Manager
Name: Name:
Designation: Designation:
Date: Date:
   
Office Seal: Office Seal:
   
   
(If more than one Employer, all of them shall sign and enter their details)
   
Submitted to:  
                      The Inspector of Factories and Boilers/  
                      Additional Inspector of Factories/  
                      Assistant Labour Officer/  
                      …………………………………………………  
   
Copy to:                     The Regional Joint Director of Factories &  
                      Boilers/District Labour Officer (E)  
                      …………………………………………………  
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FOR OFFICE USE
 
Date of receipt of the proforma in the office of the Authority …………………………………
 
Remarks of the Authority if any,
 
 
  Signature:
Office Seal: Name & Address of the Authority
 
Place:
Date:
 
 
   
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