OSH Code · Form XXII
Form XXII — Proforma of Licence
Form XXII of the OSH & Working Conditions (Central) Rules 2026, prescribed under Rules 89(1), 90(2).
Rule: Rules 89(1), 90(2) · Signed by: State Authority
What the form records
- Licence No.
- Reg. No.
- Date of Reg.
- Licence is hereby granted to
- for the premises known as
- situated at
- nature of work
- The ______ 20.. (date of issue)
- Issuing Authority
- Sl.No.
- Period of issue
- Valid For - Maximum number of Contract labour on any one day
- Fee
- Date of Payment
- Excess fee for late payment
- Date of payment (late fee)
- Signature of the Issuing Authority
- Amendments - Year when Amended
- Amendments - Maximum number of Contract labour on any one day
- Amendments - Date of payment of amendment fee
- Amendments - Date of Payment
- Amendments - Signature of the Issuing Authority
- E-sign/digital sign of the designated authority
Part of the Seventh Schedule to the OSH & Working Conditions (Central) Rules 2026. View the official form layout in the gazette, or open the OSH Code forms in MedFactory.
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