BLOCK–I             IDENTIFICATION PARTICULARS

1.

Industry Code

6.

Sector Code $

2.

Stratum Code

7.

Reference Date

3.

Size Group Code @

8.

Number of Persons employed on the Reference date

4.

Sl. No. of the Unit

in the Frame

Manual

Non-Manual

Total

a.

Sample List

9.

Name of the Industry

b.

Substitute List

5.

Sl. No. of the Unit in

10.

Name of the Establishment

a.

Sample List

b.

Substitute List

11.

Complete Postal Address

12.

Name and Address of the Employer’s Association of which the Employer is a Member.

13.

Is the Unit covered by any Wage Agreement? If yes, attach a copy.

Sample Sl. No.

BLOCK-II                 EMPLOYMENT

(A)      TIME-RATED WORKERS

Sl.

No.

Occupations

Number of Full Time Manual Workers on Pay Rolls on the Reference Date @

Title

Code

Men

Women

Adole-

scents

Child.

Total

(4-7)

1

2

3

4

5

6

7

8