Form II

{See Rule 3(7)}

Certificate of Registration of Establishment

Registration No.:

Date:

A Certificate of registration containing the following particulars is

hereby granted under sub-section(1) of section3 of the Occupational

Safety,Health and Working Conditions Code,2020(………of 2020)

to…………………….. (Name of the establishment):

1. Nature of work carried on in the establishment (Please tick mark)

a) Motor Transport Undertaking:

b) Contract Work:

c) Building and Other Construction Works:

d) Any other work (not covered above):

2. Details of workers in the establishment:

Sl.No Details of workers/Employees No of employees

1 Total Number of employees/workers engaged directly

in the establishment

2 Number of Build & Other construction workers

3 Number of the employees/workers engaged through

contractor including ISM workers

4 Number of plantation workers

5 Number of Motor transport workers

6 Number of Newspaper establishment employees

7 Number of Audio- Visual workers

8 Number of factory employees/workers

3(a). For Building and other construction work:

Type of Probable period of Expected period Details of

Construction commencement of for completion of approval of the

work work work local authority

1 2 3 4

3(b). For Motor Transport Undertaking:

Postal Name & No. of Registration No. of No. of

Address of Address of Vehicles No. of Staff&Perma Drivers&Cl

Transport the &Types of Vehicles nent eaners&

Undertaking Occupier & Vehicles Workers Others

Manager

3(c). For Contractor and work details:

Sl. Name and Name/nature Location Period of Maximum Number of

No permanent of Work of Contract Workmen Employed by

. Address of where Contract each Contractor

the contract From To Contract Interstate

Contractor workers are Workers Migrant

employed Workers

3(d). Other Establishments:

Sl. Name of the Nature of work No of Registratio

No establishment employees/ n Valid up

workers to

1 Newspaper Production (or) Publication of News

establishment Paper/News/advertising Agency /

Syndicate

2 Audio-Visual Animation/Cartoon depiction/ Audio-

production Visual advertisement/ Digital

Production/ Features Films/Non-

Feature Films/ Television/ Web-based

Serials/ Talks Shows/ Reality Shows/

Sport Shows/ others

3 Plantation Tea / Coffee / Rubber / Cinchona (or)

Cardamom etc

4 Factory Manufacturing process (Specify from

the list)

4. Amount of registration fee paid…..

5. Remarks of registering officers.

Signature E–Sign /DSC of Registering Officer

Place: along with designation

Date:

Conditions of Registration

1. Every certificate of registration issued under rule 3 shall be

subject to the following conditions, namely:

(a) The certificate of registration shall be non-transferable;

(b) The number of workers employed in an establishment directly and

contract employees shall not,on any day,exceed the maximum

number specified in the certificate of registration and

(c) Save as provided in these rules, the fees paid for the grant of

registration certificate shall be non-refundable.

2. The employer shall intimate the change, if any, in the number of

workers or the conditions of work to the registering officer within 30

days.

3. The employer shall, within thirty days of the commencement and

completion of any work, intimate to the Inspector-cum-Facilitator,

having jurisdiction in the area where the proposed establishment or as

the case may be work is to be executed, intimating the actual date of

the commencement or, as the case maybe, completion of

establishment such work in Form IV annexed to these rules

electronically.

4. A copy of the certificate of registration shall be displayed at the

conspicuous places at the premises where the work is being carried

on.