FORM N [See Rule 15] Prosecution during the year ending Period.

Name and address of the Establishment / Factory:

Nil

1 2 3 4

Place of employment the women employed Number of cases instituted Number of cases which resulted in conviction Remarks

Nil Nil Nil Nil

N.B.: Reasons for prosecution should be given in full in the Appendix below. for Place:

Date: /01/2012

Signature of Manager