श्रम आयुक्त 
(PRESCRIBED UNDER RULE 80)
REGISTER OF ADULT WORKERS
| Number and date of Certificate, if an adolescent | |||||||||
| Serial No. | Name | Father's Name | Residential Address | Nature of Work | Letter of group as in Form No. | Number of relay, if working in shifts | Number of Certificate and Date | Token Number giving reference to the Certificate | Remarks |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |