Form VI

[See rule 4(1)]

Notice of Commencement / cessation of operations

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 :-

A. Notice of Commencement / cessation of operations

I/We hereby intimate that the operation of establishment having registration No. .................................................................................... dated

…………………………………… has commenced with effect from ………………………………………. (Date) and approximate

duration of operation is __________ year______month.

OR

I/We hereby intimate that the operations of the establishment having registration No. ............................................................................... dated

…………………………………… has ceased with effect from ……………………………………………………. (Date).

[Strikeout whichever is not applicable]

B. Certificate from employer in case of cessation of operation

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 is not applicable]

Signature of the Employer

To,

The Registering Officer

The Inspector-cum-Facilitator