The Occupational Safety, Health and Working Conditions (Central) Rules, 2026

Rule Form II Form II

Chapter: Annexures · Forms and Appendices
Text as on: As notified 08 May 2026

FORM-II [(See rule 3(10)] Application for cancellation of Registration Certificate of establishment

1. Registration No:

2. Name and Address of Establishment:-

3. Name and Designation of employer :-

4. Full address to which communication relating to the establishment to be sent :-

5. Nature of work of the establishment :-

I/We here by intimate that the establishment having registration No. .......................... dated...................... is closed with effect from.................................. (Date).

Certificate from Employer

I/we hereby certify that the payment of all dues to the workers employed in the establishment having registration no. ____ dated______ has been made.

I/we hereby certify that the establishment having registration no. ____ dated______ kept free from storage of hazardous chemicals and substances. [Strikeout whichever if not applicable]

Signature of the Employer To,

The Registering Officer The Inspector-cum-Facilitator

Place: Signature/ E-sign/digital sign of employer

Date:

FORM-II
[(See rule 3(10)]
Application for cancellation of Registration Certificate of establishment

1. Registration No:
2. Name and Address of Establishment:-
3. Name and Designation of employer :-
4. Full address to which communication relating to the establishment to be sent :-
5. Nature of work of the establishment :-

I/We here by intimate that the establishment having registration No. .......................... dated......................
is closed with effect from.................................. (Date).

Certificate from Employer

I/we hereby certify that the payment of all dues to the workers employed in the establishment having registration no. ____ dated______ has been
made.

I/we hereby certify that the establishment having registration no. ____ dated______ kept free from storage of hazardous chemicals and substances.
[Strikeout whichever if not applicable]

Signature of the Employer
To,

The Registering Officer
The Inspector-cum-Facilitator

Place:                                   Signature/ E-sign/digital sign of employer

Date: