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  • WCR-1 Workers Compensation Registration Form

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    ney issa
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    This document contains a registration form for employers to register with the Workers Compensation Fund. It requests information such as the employer name, contact details, date operations began and ended if applicable, whether the employer is public or private, the nature of business, categories of employees including permanent, temporary and specific task, and a declaration signed and dated by an authorized representative of the employer.

    Original Description:

    En1511532240-Employer Registration Form WCR-1

    Original Title

    En1511532240-Employer Registration Form WCR-1

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    This document contains a registration form for employers to register with the Workers Compensation Fund. It requests information such as the employer name, contact details, date operations began and ended if applicable, whether the employer is public or private, the nature of business, categories of employees including permanent, temporary and specific task, and a declaration signed and dated by an authorized representative of the employer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    28 views1 page

    WCR-1 Workers Compensation Registration Form

    Uploaded by

    ney issa
    This document contains a registration form for employers to register with the Workers Compensation Fund. It requests information such as the employer name, contact details, date operations began and ended if applicable, whether the employer is public or private, the nature of business, categories of employees including permanent, temporary and specific task, and a declaration signed and dated by an authorized representative of the employer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    WCR-1

    WORKERS COMPENSATION FUND


    REGISTRATION OF EMPLOYER
    _______
    (Made under regulation 9 (1))
    ________

    (Complete this form in block letters and mark (√) appropriately)


    (Note: Information in this form should be provided separately when an employer has more than one
    business)

    1. Identification
    Name of employer ………………………………………………………………………………….........
    Contact address ………………………..….........Street/village…………………………..........................
    District……...…………………….Region……………………………Country………………………...
    Plot no………………….................Block no…………………………………………………………….
    Tel …………………………..Fax………………………Cellphone……………………………………..
    E-mail…………………………………………………………………………………………………….
    Date of commencement of operation……………………………………………………………………..
    Date of closure of operation (if applicable) .………………......................................................................

    2. Category of employer (Mark ( √ ) where appropriate)


    S/No. Category of Employers Status
    1. Public
    2. Private

    3. Nature of business (e.g. manufacturing, construction)


    …..…………………………………………………....................................................................................
    ……………………………………………………………………………………………………………..

    4. Categories of employees

    S/No. Category of Employees Female Male Total


    based on the Contract of
    Employment
    1. Permanent (Unspecified
    period of time)
    2. Temporary (Specified period
    of time)
    3. Specific task

    (Attach a list of names of all employees)

    5. I,…………………………………………………, declare that what I have stated herein above is true to


    the best of my knowledge.

    Name………………………………………………………………………………………………………
    Designation……………………………………………………………………………………………….
    Signature…………………………………………………………………………………………………..
    Date………………………………………………………………………………………………………..

    Official Stamp of the employer

    Page 1 of 1

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