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[{"$nulls":10},"Form No: ICF 2A"]
[]
[{"$nulls":9}," WORKMAN'S IICF #:………………"]
[]
[]
[]
["SOCIAL SECURITY & HOUSING FINANCE CORPORATION"]
["       INDUSTRIAL INJURIES COMPENSATION FUND"]
["            WORKMAN'S REGISTRATION FORM"]
[]
["   EMPLOYER:…………………………………………………………………………………………."]
[]
["   FULL NAME OF WORKMAN:………………………………………………………………………………………."]
[]
["   WORKMAN'S PAYROLL NUMBER:…………………………………"]
[]
["   PERMANENT ADDRESS:………………………………………………………………………………………….."]
[]
["    …………………………………………………………………………………………………………………………"]
[]
["   OCCUPATION:…………………………………………….     NATIONALITY:…………………………………….."]
[]
["   SEX: (M):…………………(F):……………………",{"$nulls":4},"                ","       MARITAL  STATUS:………………………………."]
[]
["   DATE OF BIRTH:………………………………………….     DATE OF EMPLOYMENT: ……………………..."]
[]
["   GROSS MONTHLY EARNINGS:…………………………"]
[]
["    NOMINATION"]
["     WORKMAN'S  NOMINEES:"]
[]
["Name",null,null,null,"Address",null,null,"Date of","Relationship/",null,"Proportion of "]
[{"$nulls":7}," Birth","Dependancy",null,"Benefits"]
{"$rows_empty":17}
["       IF EMPLOYEE HAS NO DEPENDENTS, A SWORN AFFIDAVIT TO THAT EFFECT WILL BE REQUIRED"]
[]
["       Please note that ICF Numbers are allocated by SSHFC."]
[]
["       Date:…………………                   Workman Signature or thumb print……………………………………………."]
[]
[]
[{"$nulls":4},"Employer's Signature:………………………    Date:…………………………."]
[]
[{"$nulls":4},"Name in full:……………………………………………………………………."]
[]
[{"$nulls":4},"Designation:……………………………………………………………………."]

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