Labour And Employment THE PONDICHERRY UNORGANISED LABOURERS' WELFARE SOCIETY (REGN. NO. 44/2001) MEMBERSHIP ENROLMENT APPLICATION Members Regn. No................. (To be filled by the Office) 1. Name of the Worker 2. Sex -Male/Female 3. Name of Father/Husband 4. Date of Birth (Enclose Certificate in proof of age) 5. Whether married/Unmarried/ window/widower? 6. Permanent Address 7. Present Address 8. Community -SC BC General 9. Mention whether the applicant is Self-employed or working some-where 10. If he works in any concern, the name and address of the Establishments/ employer/contractor be furnished 11. Nature of work 12. No of years of Service rendered on the date of application 13. Blood Group 14. Family Particulars - 15. (a) Whether husband or wife is SL. No Name Relation Marital Status employed -yes/No (b) If yes, details thereof 16. Nomination Form - Name and Relationship of Age of the Amount of Share address of the the worker with Nominee to be paid for Nominee / the Nominee each Nominee Nominees (1) (2) (3) (4) Place: Date: Signature of Left Hand Thum impression of the Unorganised worker
