Form 3A

[See sub-rule (4) of Rule 5]

CERTIFICATE OF REGISTRATION OF ESTABLISHMENT

Registration No.: _____ /OSH/REG/_______ Date of Issue:

A Certificate of Registration containing the following particulars for the establishment is hereby granted

under sub-section (2) of Section 3 of the Occupational Safety, Health and Working Conditions Code, 2020

and the rules made thereunder to………..(Name of Establishment).

Particulars of Establishment

1. Type of Establishment: __________ ( to be chosen from drop down)

2. Full Address of Establishment:

3. Nature of Activity / Business / Manufacturing Process:

4. Name, Address and Contact Details of Principal Employer / Occupier / Owner:

5. Name, Address and Contact Details of Manager / Person responsible for supervision and control of the

establishment:

6. Maximum number of employees / workers: ______________________

7. Total number of contract labour, if any: ______________________

8. Number of contractors, if any: ______________________

9. Number of Inter-State Migrant Workers, if any: ______________________

10. Details of Building or Other Construction Work, if applicable:

Type of Construction Probable Period of Expected Period for Details of Approval of

Work Commencement of Work Completion of Work Local Authority

11. Registration Fee Paid: ₹ ______________________

12. Amendment Details (if any):

13. Remarks of Registering Officer:

Registering Officer Name:

Designation:

Office Seal / Digital Signature

Notes:

1. This certificate is issued on the basis of the information furnished by the employer / applicant. Any

concealment or willful misrepresentation shall attract action under the provisions of the Occupational

Safety, Health and Working Conditions Code, 2020 and the rules made thereunder.

2. This certificate shall not be construed as any licence or approval required under the Code or under any

other law for the time being in force, including Factory Licence under Section 79 of the Code or licence for

engagement of contract labour, wherever applicable.

3. The employer shall ensure continued compliance with the provisions of the Code and rules made

thereunder and intimate / update any change in particulars as required

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