Name and Address of the Establishment in/ under

Form XVI - Muster Roll which contract is carried on :

(Vide rule 78 (1) (a) (I) of Contract Labour (Regulation and Abolition ) Central/ A.P
Rules.

Name and address of Contractor : Name and Address of Principal Employer:

Nature and Location of work: For the Month of :

Dates
S. Name of the Father's/ Rem
Sex
No Employee Husband's Name 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 arks
1 2 3 4 5 6

10

11

12

13

14

15

16

17

18

19

20
 Name and Address of the Establishment in/ under
Form XVI - Muster Roll which contract is carried on :
(Vide rule 78 (1) (a) (I) of Contract Labour (Regulation and Abolition ) Central/ A.P Rules.

Name and address of Contractor : Name and Address of Principal Employer:

Nature and Location of work: For the Month of :

S. Name of the Father's/ Husband's Dates Rem
Sex
No Employee Name 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 arks
1 2 3 4 5 6

10

Signature of the Site Engineer Signature of the Contractor with Seal