Form IV — Certificate of cancellation of Registration Certificate of Establishment

Rule: Rule 3(11) · Signed by: State Authority · Under: OSH & Working Conditions (Central) Rules 2026

What the form records

• No.
• Date
• Registration No.
• Dated
• Name of the establishment
• Cancelled with effect from
• Place
• Date (signature)
• Signature/ E -Sign/DSC of Registering Officer along with designation

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

MedFactory — Occupational Health Centre software for Indian factories