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:*   Ward/Corporation/Hobli :*  
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:*  
Place:

Date:                

   Signature of the Employer:*

 
               

   
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