श्रम आयुक्त 
(PRESCRIBED UNDER RULE 12A)
NOTICE OF CHANGE OF MANAGER
- Name of factory with current license number....................................................................
- Postal address....................................................................
- Name of outgoing manager....................................................................
- Name of new manager with postal address of his residence and telephone number, if installed....................................................................
- Date of appointment of the new manager with parentage....................................................................
Date
Signature of new Manager
Signature of Occupier
Place