FORM 20 (Prescribed under sub rule (2) of rule 110) HALF YEARLY RETURN Period ending 30th June 200 Name of Factory _ Name of occupier _ Name of manager _ 1. District _ 2.Postal Address _ 3.Nature of Industry _ 4. Average number of workers employed _ daily __ (a) Adults Male _ Female _ (b) Adolescent Male _ Female _ Children _ 5. Number of days worked during the half _ year ending 30th June 200 Certified that the information furnished above is correct to the best of my knowledge and belief. Signature of Occupier Signature of Manager