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: