Form XVI

{(See Rule 44(1) & Rule 65(5)(a) & Rule 166)}

Proforma of License / Renewal of License

LicenceNo.------------- Reg.No.----------- Date of Reg.----------

Licence is here by granted to …………………………………………………for the

premises known as ……………………………..situated at………………………… nature of

work…………………… for use as a establishment within the limits stated herein

after,subject to provisions of the Occupational Safety,Health and Working

Conditions Code, 2020, and the rules made there under.

The------------20.. Issuing Authority

Excess Signature

Sl. Perio Valid for Fee Date of fee for Date of of the

late Issuing

No d maximum number payment paymen

paymen Authority

of contract t

t

labour/workers on

any one day

AMENDMENTS:

Year when Maximum number of Date of Date of Signature of the

amended Contract labour/ payment of Payment Issuing Authority

amendment

Workers on any one

fee

day

The amendment for Licence is issued on this the _______ day of _________,

2026.

E sign/digital sign of the designated

authority

TERMS AND CONDITIONS

1. The licence shall be non-transferable except in case of death of

licensee as specified at rule 52.

2. The number of workers employed as contract labour by the contractor

shall not, on any day, exceed the maximum number specified in the

licence.

3. Save as provided in these rules, the fees paid for the grant, or as the

case may be, for renewal of the licence shall be non-refundable.

4. The rates of wages payable to the workers by the contractor shall not

be less than the rates prescribed under the Code on Wages, 2019 and

where the rates have been fixed by agreement, settlement or award,

not less than the rates so fixed.

5. In respect of licence granted to Beedi and Cigar Establishment,

(i) The manufacturing process shall be carried on only in that part of

the premises specified in the Licence.

(ii) The total number of employees employed in the premises shall not

on any day, during the period of the Licence, exceed that specified

in the Licence.

(iii) No machinery or power which has not been specified in the Licence

shall be used in the manufacturing process in the premises.

(iv) No industrial premises reconstructed or extended subsequent to

the grant or renewal of the Licence shall be used as industrial

premises except with the written permission of the licencing

authority.

(v) The Licence shall not be transferable from one employer to another

except in the cases and in accordance with the procedure specified

in rule 52.

(vi) The fees paid shall not be refunded except in the cases specified in

rule 67.