Form II

(See Rule - 5)

Certificate of Registration of Establishment

Registration No. Date:

A Certificate of registration containing the following particulars is hereby granted under sub

section (2) of section 3 of the Occupational Safety, Health and Working Conditions Code, 2020 to

(Name of the establishment)

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

(a) Audio-Visual Production (b) Beedi & Cigar Work

(c) Building and Other Construction Works (d) Contract Work

(e) Motor Transport Undertaking (f) Plantations

(g) any other work (not covered above)

2. Details of the establishment:

(a) Total Number of employees engaged directly in the establishment:

(b) Total Number of the employees engaged through contractor………..

(c) Total Number of Contractors and their details:

(d) Number of Inter-State migrant workers engaged:

3. (a) For Audio-Visual Production:

Name and address of the Production House Maximum number of audio-visual workers to be

or the Producers of the Production House employed on any day

1 2

(b) For Beedi & Cigar Work:

Whether the

employer is a Whether the

Financial

trademark proposed site of the

Resources of the Value of beedi

holder Previous industrial premises

Employer (e.g. – or cigars or both

registered experience amounts to

particulars and manufactured at

under the of the alteration of the site

value of movable the industrial

Trade and employer in of any existing

properties, bank premises during

Merchandise the industrial premises

reference, the preceding

Marks Act, industry. and, if so, the

income tax year.

1958, If yes, reasons for such

assessment etc.)

the registration alterations.

number

1 2 3 4 5

(c) For Building and Other Construction Work:

Probable period of

Type of Expected period for Details of approval of

commencement of

Construction work completion of work the local authority

work

1 2 3 4

(d) For Contract Work:

Name and Address of the Contractor(s) Maximum number of contract labour to be

engaged in any day

1 2

(e) For Motor Transport Undertaking:

Maximum

Name of motor

number of

transport service

Total number motor Full name

(e.g. – city

of transport transport Name and and address

service, long Total Total

vehicles on workers address of of the

distance number of Route

the last day of employed on the Directors, in

passenger Routes Mileage

the preceding any day employer case of a

service, long

year during the Company

distance freight

preceding

service etc.)

year

1 2 3 4 5 6 7

(f) For Plantations:

Full name and Name of the hazardous

Maximum number

Total area of Name and address of the chemicals, insecticides,

of workers to be

plantation in address of Directors, in pesticides to be handled

employed on any

hectares the employer case of a and stored along with its

daydfdf

Company quantity

1 2 3 4 5

4. Amount of registration fee paid…..

5. Remarks of Registering Officers

Place: Signature E -Sign/DSC of Registering

Date: Officer

along with designation

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 30days

(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 may be, completion of 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.