Rule Form IV Form IV
- Chapter
- Annexures · Forms and Appendices
- Text as on
- As notified 08 May 2026
FORM-IV [(See rule 3(11)] Certificate of cancellation of Registration Certificate of Establishment
No. Date:
The Registration No.......................................dated........................ of .................................... (Name of the establishment), of Factory/ Mine/Dock Work/ Contract Work/ Building or Other Construction Work/ Any other work (work carried on in the establishment) is hereby cancelled with effect from ...................... under sub-section (5) of section 3 of the Occupational Safety, Health and Working Conditions CodeDefined in rule 2(a): Code means the Occupational Safety, Health and Working Conditions Code, 2020 (37 of 2020), 2020 (37 of 2020).
Place: Signature/ E -Sign/DSC of Registering Officer Date: along with designation