FORM IV
[See sub-rule (1) of rule 4]
Register of nominations
                       
Name and address of the mine
Name and address of the employer
PART I

Sl. No.	Name and complete address of the employed person.	Nature of Employment	Name and complete address of the nominee initially nominated in Form I with date.	Name and address of the nominee subsequently nominated in the nominated in Form II with date.	Details of modification if any specified in the notices of modification of the nomination 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 I.