Factories Act · Form 22
Form 22 — Nomination for Pay Due in Event of Death of Worker
Worker nominates beneficiary for pay due on death before resuming work.
Rule: Rule 118 · Signed by: Worker
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
Blank statutory template. Fill, save and print Form 22 in MedFactory, or view the official layout in the Model Factories Rules gazette.
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