Form II — Application for cancellation of Registration Certificate of establishment

Rule: Rule 3(10) · Signed by: Occupier · Under: OSH & Working Conditions (Central) Rules 2026

What the form records

• Registration No
• Name and Address of Establishment
• Name and Designation of employer
• Full address to which communication relating to the establishment to be sent
• Nature of work of the establishment
• Establishment having registration No.
• Dated
• Is closed with effect from (Date)
• Certificate from Employer: payment of all dues - registration no.
• Certificate from Employer: payment of all dues - dated
• Certificate from Employer: free from storage of hazardous chemicals - registration no.
• Certificate from Employer: free from storage of hazardous chemicals - dated
• Place
• Date
• Signature/ E-sign/digital sign of employer

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

MedFactory — Occupational Health Centre software for Indian factories