Form of Certificate by Principal employer

Certified that:

i. I have engaged the applicant ………………………… (name of the contractor) as a contractor in

my establishment for the work_____________ to be carried out from ____________(date) to

__________(date).

ii. I undertake to be bound by all the provisions of the Occupational Safety, Health and Working

Conditions Code, 2020 and the Uttar Pradesh Occupational Safety, Health and Working

Conditions Rules, 2021 in so far as the provisions are applicable to me in respect of the

employment of contract labour/inter-state migrant workmen* by the applicant in my establishment.

iii. The engagement of contract labour in the said work is not prohibited under section 57 of the

Occupational Safety, Health and Working Conditions Code, 2020 or an award or a settlement.*

iv. My registration number as Principal Employer under the Code is ………………..

*Please strike off whichever is not applicable.

Date: Signature of Principal

employer

Place: Name and Address of

Establishment