FORM IV
[See sub-rule (1) of rule 4]
Register of nominations.

Name and Address of the establishment.         Name and address of the employer.
PART-1

SI. No.	Name and complete address of the employed person	Nature of employment	Name and complete address of the nominee initially nominated in Form.1 with date	Name and address of the nominee subsequently nominated in Form II with date	Details of modification if any. Specified in the notices of modification given in form III with date	Remarks
1	2	3	4	5	6	7

PART II
It shall contain one copy each of the nomination in Form I and, as the case may be, the fresh nomination in Form-11 and notice of modification of nomination in Form III in serial order indicated in Part-1.