FORM XV
(See rule 77)
Service Certificate
The Contract Labour (Regulation and Abolition) Rules 1974
Name and address of contractor : GI STAFFING SERVICES PVT.LTD
F 103 ASHISH COMPLEX MAYUR VIHAR PHASE I DELHI 110091
Name and address of establishment : LG Electronics India Private Limited,
in/under which contract is carried on 55/A Rama Road, Block B, Najafgarh road, Industrial Area
New Delhi-110015
Nature and location of work : Staffing Services, Delhi
Name and address of principal employer : LG Electronics India Private Limited,
55/A Rama Road, Block B, Najafgarh road, Industrial Area
New Delhi-110015
Name and address of the workman : Pawan
Age or date of birth : 27/07/1992
Identification marks : GI-167424
Father’s/Husband’s name : Biram Singh
Sl. Total period for Nature of work done Rate of wage (with Remark
No. Which employed Particulars of unit
in case of piece
From To work)
1 2 3 4 5 6
08/02/2023 to 01/06/2023 Admin/Mis -
Signature………………………
FORM XV
(See rule 77)
Service Certificate
The Contract Labour (Regulation and Abolition) Rules 1974
Name and address of contractor : GI STAFFING SERVICES PVT.LTD
F 103 ASHISH COMPLEX MAYUR VIHAR PHASE I DELHI 110091
Name and address of establishment : LG Electronics India Private Limited,
in/under which contract is carried on 55/A Rama Road, Block B, Najafgarh road, Industrial Area
New Delhi-110015
Nature and location of work : Staffing Services, Delhi
Name and address of principal employer : LG Electronics India Private Limited,
55/A Rama Road, Block B, Najafgarh road, Industrial Area
New Delhi-110015
Name and address of the workman : Sachin Ghai
Age or date of birth : 04/05/1979
Identification marks : GI-169958
Father’s/Husband’s name : Keemati Lal Gai
Sl. Total period for Nature of work done Rate of wage (with Remark
No. Which employed Particulars of unit
in case of piece
From To work)
1 2 3 4 5 6
04/04/2023 to 30/04/2023 Engineer Field (Rep) -
Signature………………………
