(1) The power to interpretation of the provisions of any rules are vested in the State Government.
(2) If any practical difficulty or doubt arises in the implementation/ administration of schemes being carried out by the Board shall be referred to the State Government and the State Government shall take decision in the matter after consultation with U.P. State Social Security Board.
By order, RAJENDRA KUMAR TIWARI, Principal Secretary.
1 Notification no. 08/2024 /24-12/XXXVI-03-2024-1790704 dated 23 December, 2024 Duplicate Identity card Facilitation Centers for unorganized werkers ef records in rapeet of registered/ benficiaries Removal difficulties & doubts.
- V - \ _ उत्तर प्रदेश जसाधारण गजट, 19 अक्टूबर, 2016 17 !
Sedalno. .._.... Registration no, of worker.
FORM.A (To be filled by registering officer) = [(See rute 232 i Utlar Pradesh State Social Security Board 3 - Form 6, Applicatrion for Registration Unorganized Workers
1. Name:
~Male [ Female (] एप
2. Name of Fa!heranther/Husbmui.m
3. Nature of work/Employment of the applicant (worker); 4. Address for corvespondance of applicam : .
L——,&lm 6. Marital Status (Married, Unmarzied, Widow, Divorced)
7. Date of Birth ...
8. Registratio/Contribution amount R: -~ Deposited (] Not deposited 1 9. 1 the applicant is member of any other previous warker’s Welfare Board, then name of the Board and it registration number :.._
10. Name of dependeat, age, relation and address etc.
(A) Name of Wife/Husband L
(8) Name of Father/Mother दे ८) गाए of Dependent miner So/daugh (D) Ocher 11, Records enclosed:; (1)......
(3)......
- ) I certify that above entries are true 10 my knowledge and belief.
T Place ;.
Dated : ....
(है;
(Signature/Thumb impression of the Worker) I'am satistied with the claim of unorganized worker on short enquity/investigution from the applicant.
L Approved/Disapproved for Tegistration, Signatwe of Competent Authority/Name:....
Designation/Stamp :..
MSm‘m no. ..
Dated ...
Signature of the recipient designation/Stamp नए लए (¥ scanned with OKEN Scanner उत्तार प्रदेश असाधारण गजट, 19 अक्टूबर, 2016 18 Auoginy wmadiwo) 3y jo w e N R e किसके Gauow 'मर्भ00/0. paziueBioun ४ ० su pho e व आ ग ल ि न न dumg पाए Aipoupry wardaios jo simeuis | i — { Ruoyny oy .
nquiuos Ju3duy "~ Jo u_.fi_.m.om u_:eflu:._oe uonnquiuos w u fl fi _ u fl " 1 य ९ शण्प |30 wnomy 30 भ०0 ' (o215 vodrsagy 4 w o 5 " 4RaIoioud 1uaoey 3ourpRodsanoy agy P P Y W b « .
u :
u _ .
u a ?
w i e ?
1० यबष्८ 8०५०५, PURGSIH/ISON 1 jo ourmy o रण्ठणाण्जा % T R 126z a1ma 3agy) T I N N O 4 (¥ scanned with OKEN Scanner दी0-ए0दी0 536 राजपत्र हिंए)-2016 (1229)-599 प्रतियां:
doqwogdo—od a7 'सा0 श्रम-2010- 052 8 ए526171.2016 Shu-eny 6:06
(1230)~600 प्रतियां- (कम्प्यूटर /टी0/आफसेट)। ६2६7 for registration of Ugorganized Workers sL Name of Wosker! Bencficiary Duicof | Pomanent | Address for Gender | Evploymen/ | Registration. Reglstration foc statemeat Signatwreof | Remarks o0 Neme of Birdv Age | Address | Corespondance | Male/Female | Occupmion | noJ/Date registratiol 2 Name of | Draft no./ Fee officer with date herMother/Hushand Bank Date s (Rs) - _ n _ — “ 7 n - n n 12 13 . | 2 & : % 4 ] g 2 i = N 2 a -(कम्प्यूटर/ Ao / आफरोट) - © (¥ Scanned with OKEN Scanner