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.