Form 4 (WELFARE FUND SCHEME)

KERALA SHOPS AND COMMERCIAL ESTABLISHMENTS WORKERS WELFARE FUND SCHEME, 2007

FORM -4

List of Employees

[See Para 30(1) of the Scheme]

1.  Name and address of the Establishment            :

2.  Name and address of the Employer                   :

3.  Registration No. of the establishment under

     Kerala Shops & Commercial Establishments Act 1960.  :

4. LIST OF EMPLOYEES

Sl. No.	Name	Designation	Age and date of birth	Date of joining	Whether enrolled in welfare fund, if so date	Remarks
1	2	3	4	5	6	7

                                                                                                  Signature of the employer.

Form B1 ( Registration/ Renewal)

FORM No.B1

(See Rule 2A and B)

                                                                                      Regn.Certificate.No: …………

Application for grand of the renewal / Registration Certificates for the year………..

1. Full name of Establishment                                :

2. (i)   Full address of establishments                     :

                   with Door No. Street etc.

(ii)     Full address to which communications                    :

        relating to the Establishments should be sent

(iii)    Name and full address of the Employer                  :

3. whether Shop or Commercial Establishment                  :
4. (a) The No. and Name of employees in the

             Establishment during the current year

      (b) The No. and Name of employees in             :

             the Establishment during the previous year

(a list of names be attached)

5. (a) Full Name and Residential Address of the who         :

            shall be the Employer for the purpose of the Act.

      (b) Full Name and Residential Address of the whom      :

            shall be the Manager for the purpose of the Act.

6. If the employer is a partnership company etc.    :

       full name and residential address of the

      other partners or Directors etc.

Amount Fee Rs :………….( Rupees………………………………………….….) paid in Treasury on…………………..Vide Chelan No………… dated:………… enclosed.

I hereby declare that the particulars furnished by me in the form are correct to the best of my knowledge and belief.

Date:                                                                            Signature of the Employer

Form B III

Form “B III”

[See Rule 2D (2)]

Notice of changes for amending Registration Certificate

1. Name of the Establishment and address thereof :

2. Name of Employer                                             :

3. Particulars of changes for amendment               :

4. Details of circumstances under which

            the changes were effected                                  :

5. Remarks                                                              : 

Date:                                                                               Signature of the Employer

Place:

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