Form XV

Made under The Occupational Safety, Health and Working Conditions Code, 2020Notification No. 101, 30 Jun 2026

Official text

Open in the official PDF (p. 393)

Tables and forms lose their layout when extracted; the PDF is the authoritative version.

(Under Rule-52)

EXPERIENCE CERTIFICATE OF CONTRACT EMPLOYEE

To whom so ever concerned

1. Name of contractor/employer*:

2. LIN/PAN No. of the contractor/employer/Registration No. *:

3. Email Id of the contractor /employer *:

4. Mobile No. of the contractor/employer *:

5. Nature and location of work:

6. Name of Principal Employer*:

7. LIN/PAN No. of the Principal Employer :*

8. Email Id of the Principal Employer : *

9. Mobile No. of the Principal Employer :*

10. Name of the worker*:

11. UAN / Aadhaar No.:

12. Mobile No. :

13. Serial

14. Registration number, date and name of the Board if the building and other construction worker is

registered as a beneficiary:

15. Period of Employment:

16. Designation:

Seal and Signature of Contractor

*Please strike off whichever is not applicable.

Source: The Occupational Safety, Health and Working Conditions (Bihar) Rules, 2026, Notification No. 101 — Bihar Gazette Extraordinary No. 699, 1 July 2026, p. 393 of the PDF. Open our copy at p. 393 · official download · all sources