Workshop for Representatives of Exempted & Un-Exempted Establishments on 21-22 February 2013 at Mumbai - Inviting Nominations NATRSS No. 13/27/2012-13/NATRSS/4374 dated 04/02/2013

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राष्ट्रीय सामाजिक सुरक्षा अनुसंधान एवं प्रशिक्षण अकादमी NATIONAL ACADEMY FOR TRAINING & RESEARCH IN SOCIAL SECURITY कममचारी भववष्य ननधध संगठन –श्रम मंत्रालय भारत सरकार Employees' Provident Fund Organisation(Ministry of Labour, Govt. of India) 30-31, इंस्टीट्यूिनल एररया,िनकपुरी, नई ददल्ली 110 058 30-31, Institutional Area, Janak Puri, New Delhi-110058 दूरभाष-28525993फैक्स-28524079 Phone: 28525993 Fax: 28524079 Phone: 011-28520468 (After office Hours/Holidays) website- www.natrss.gov.in Email.natrss@hotmail.com NOMINATION FORM Name of the Programme: Workshop for Representatives of Exempted & Un-Exempted Establishments on EPF & MP Act, 1952 & EPS, 1995 Date:21-22 February 2013 Venue: The International Convention Hall, BSE Institute Limited, P.J. Towers, Dalal Street, Mumbai - 400001 1. Name (in BLOCK letters): SURNAME……………. MIDDLE NAME………….. FIRST NAME:…………………….. 2. Sex ( Male / Female):……………………… 3. Educational/Professional :……………………………………………………………………………………..................... Qualification :…………………………………….…………………………………………………................ 4. Name & Address of the Organization ………………………………………………………………………………………… …..……………………………………………………………………………………………………………………………………………… 5. Designation (Present Title of your Job) :…………………………………………………………………….. 6. Working Experience (No. of Years) :.………………………………………………………………………. 7. Telephone Nos. (code) : ………….. : Office:………………………..Residence:………………………………... : Mobile:……………………… Fax:……………………………................... 8. E-mail address: (i) Personal:…………………………………………………………(ii)Office :………………………………. 9. Details of the Bank Draft: i) DDNo……………………….ii)Date……………iii)Amount:……………………. iv) Bank’s Name:………………………………………………………………………… 10. What are your expectations from this programme…………………………………………………………………… …………………………………………………………………………………………………………………………………………………….. 11. Have you ever attended any Training/Workshop/Seminar at NATRSS? : Yes / No If yes, please indicate Name & date of the programme:....................................................................................... …………………………………….. …………………………………………………………… (Signature of Participant) (Signature of the Sponsoring Authority) certifying the above information with stamp Participation fees deposited in favor of National Academy for Training & Research in Social Security, Account No. 10502082571 Branch: CCRAS, Janakpuri, New Delhi payable at New Delhi. For further clarification please contact Shri M.S. Bhatia at No. 011-28525993, 011-28524078.