Form No. 21
(Prescribed Under Rule 19)

HEALTH REGISTER

In respect to persons employed in occupations declared to be dangerous operations under section 87

Name of Certifying Surgeon :

(1) Serial No. :
(2) Deptt & Code No. : []
(3) Name of Employee : Vijay Gehlot  
(4) Sex :
(5) Date of Birth :
(6) Age