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FORM IV

[See sub-rule(3) of Rule 17]
Notice of Commencement / Completion Of Building And Other Construction Work by the Employer
Employer / Contractor
 
Commencement / Completion
 
 
 
Name of the establishment where building or other construction work is to be carried on*
 
location of the establishment where building or other construction work is to be carried on :*
 
 
Postal address of the establishment :*
 
 
Full name of the establishment, if any :*
 
Permanent address of the establishment, if any :*
 
 
District :*
 
Sub Division :*
 
 
Taluk:*
 
 
Mobile Number :*
   
Email ID:*
 
 
 
Full name of the manager or person responsible for supervision and control of the establishment:*
 
Address of the manager or person responsible for supervision and control of the establishment:*
 
 
Nature of building or other construction work carried/ is to be carried on in the establishment:*
 
Maximum number of building workers to be employed on any day:*
 
 
Estimated date of commencement of building or other construction work:*
 
dd-MM-yyyy  
Estimated date of completion of the building or other construction work:
 
dd-MM-yyyy  
 
Building or Other Construction work Completed Date
 
dd-MM-yyyy  
Remarks
 
 
The arrangement storage of explosives,if any, to be used in building or other construction work:*
 
In case the notice is for commencement of work, the approximate duration of work:*
 
 
Date:(dd-MM-yyyy)
place:
Signature of the Employer: