Form 5

{see sub-rule (1) of rule 7}

Notice for commencement or cessation or completion of work

A- Notice of Commencement / cessation of Establishment:

1. Registration No and type of establishment:

2. Name and Address of Establishment:-

3. Name & Designation of employer:-

4. Full address to which communication relating to the establishment to be sent :-

5. Nature of work of the establishment :-

6. In case of the notice is for commencement of work the approximate duration of work {(in case

of Establishment relating to BOCW)}:-

7. in case of cessation, the date of cessation:

I/We hereby 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)

B- In case of cessation of work:

I/we hereby certify that the payment of all dues to the workers employed in the establishment have

been made and the premises are kept free from storage of hazardous chemicals and substances.

Signature of the Employer

To,

1. The Registering Officer,

………………………

2. The Inspector-cum-Facilitator,

…………………