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FORM V

[See rule 21 (2)]

Form of Certificate by Principal Employer

Certificate that I have engaged the applicant M/s. Shree Kshemklyani Enterprise as a contractor in my

establishment, I undertake to be bound by all the provisions of the contract Labour (Regulation and Abolition)

Act, 1970, and the Gujarat Contract Labour (regulation and Abolition) Rules, 1972, in so far as the provisions

are applicable to me in respect of the employment of contract labour by the applicant in any establishment.

Place: Bharuch

Date: 26/06/2019 Signature of principal employer:

Establishment Registration Number: - BCH/2017/CLRA/01 dated 02/01/2017

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