Form 22 — Nomination for Pay Due in Event of Death of Worker

Rule: Rule 118 · Signed by: Worker · Under: Factories Act 1948 / Model Factories Rules 2020

Worker nominates beneficiary for pay due on death before resuming work.

What the form records

• Nominee name + relation + address
• Worker signature/thumb
• Witnesses (name, designation, address, signature)
• Worker particulars (serial no., section)
• Date

This page opens the blank statutory form in MedFactory, ready to fill, save and print. See the Form 22 reference page for the rule and signatory detail.

MedFactory — Occupational Health Centre software for Indian factories