Form IV: Certificate cancelling establishment registration

Form IV: Certificate cancelling establishment registration

This is the prescribed format in the final Occupational Safety, Health and Working Conditions (Central) Rules, 2026, linked to rule 3(11). Use the original Gazette extract below to see the complete fields and declarations.

Who uses this form?

Registering authority. The form’s presence in the Library does not itself create an obligation or establish that its chapter applies to an establishment.

What to prepare

Record the cancelled registration, effective action and order details. Keep this certificate with the closure and employee-settlement records; it is issued after the cancellation process.

Choose the correct legal route

Confirm the applicable chapter, appropriate-government jurisdiction and the current procedure before filing or issuing a document. Distinguish an application, an employer-maintained register and an authority-issued notice or certificate. A form used in one process is not interchangeable with a similarly numbered form under another Code or state law.

Download and retain the source

The download preserves physical PDF pages 250–250 of the official Gazette without editing the page contents. Adjacent forms can share a source page. This is a reference PDF, not an editable template or proof of a successful portal submission. Keep the filed acknowledgement, issued order or maintained record, as appropriate, with the evidence supporting it.

Read the full official Gazette and operative rule.