Odisha Building and Other Construction Workers' Welfare Board, Bhubaneswar. Construction Worker Identity Card Form Xxviii (See Rule 266 (1) )

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ODISHA BUILDING AND OTHER CONSTRUCTION WORKERS' WELFARE BOARD,

BHUBANESWAR.
CONSTRUCTION WORKER IDENTITY CARD
FORM XXVIII
[See Rule 266(1)]

Registration Number : ODKHO002010154 Date of Registration : 30-08-2022

Name : DIBAKAR MUDULI

Sex : Male

Date of Birth : 13-06-1988

Marital Status : Married

Father’s Name : KANDURI MUDULI

Spouse Name : RANJITA MUDULI

Permanent Address : SAHASPUR KHORDHA BANAPUR Bank Details : Acc no:2255000100131053


Sahasapur 752031 Bank name: PUNJAB NATIONAL
BANK
Branch name: SALIADAM COLONY
IFSC: PUNB0225500

Present Address : SAHASPUR KHORDHA BANAPUR Religion : Hindu


Sahasapur 752031

Category : General

Physically Challenged : NO Nature of job : Unskilled Construction Worker

NFSA/SFSA Card No :
|||*|
Signed
Interstate migrant worker : NO by:CHANDAN
MAJHI
Signature of the worker : Date:
2022.08.30
16:37:49 +05:30
Place : KHORDHA

Date : 30 Aug 2022

Registration Valid Upto : 29-08-2025 CHANDAN MAJHI

Annual Contribution last : Registering Officer


paid on Assistant Labour Office Khordha
(Balugaon)

Note:- i This is a digitally signed electronically generated certificate and therefore needs no ink-signed signature.
ii This certificate is issued as per section 4, 5 & 6 of IT Act, 2000 and its subsequent amendments in 2008.
iii For verification, visit https://nirmanshramik.odisha.gov.in.
iv Tampering of this certificate will attract penal action.
v The card holder may download new updated identity card from his/ her own login dashboard in the onlineportal on expiry of validity period
subject to regular payment of Annual Contribution for renewal.

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