Form IV

{See Rule-7}

A-Notice of Commencement/completion of work/cessation of

Establishment:

1. Registration No:

2. Name and Address of Establishment: -

3. Name and Designation of employer/who has ultimate control over the

affairs of the establishment:-

4. Full address to which communication relating to the establishment to

be sent:-

5. Nature of work of the establishment:-

6. Incase of the notice is for commencement of work the approximate

duration of work:-

7. In case of completion of work/cessation of establishment,the date of

completion/cessation:

I/We here by intimate that the work of establishment having

registration No……………..dated………… is likely to commence/cessation is

likely to be completed with effect from ………….(Date)/On ……………(Date).

In case of cessation of work:

I/we here by certify that the payment of all dues to the workers

employed in the establishment has been made and the premises are

kept free from storage of hazardous chemicals and substances.

Signature of the Employer

To,

The Inspector-cum-Facilitator