Form XXIII — Experience Certificate of Contract Labour

Rule: Rule 100 · Signed by: Manager · Under: OSH & Working Conditions (Central) Rules 2026

What the form records

• Name of contractor/employer
• LIN/PAN No. of the contractor/employer
• Email Id of the contractor /employer
• Mobile No. of the contractor/employer
• Nature and location of work
• Name of principal employer
• LIN/PAN No. of the principal employer
• Email Id of the principal employer
• Mobile No. of the principal employer
• Name of the labourer
• UAN / Aadhaar No.
• Mobile No.
• Serial Number in the employee register
• Registration number, date and name of the Board where the building or other construction work is registered as a beneficiary
• Period of employment
• Designation
• Work performed
• Seal and Signature of Contractor

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

MedFactory — Occupational Health Centre software for Indian factories