FORM XIV
(See rule 50)
Service Certificate

Name and address of Contractor.        
Nature and location of work.
Name and address of the migrant workman.
Age or date of birth.
Identification marks.
Father’s/Husband’s name.
Name and address of establishment in/under which migrant workmen are employed.
Name and address of Principal Employer.

Serial No.		Total period for which employed From To			Nature of work done	Rate of wages (with particulars of unit case of piece-work)	Remarks
1	2		3	4		5	6

                                                               Signature of the Contractor or his
Authorised representative.