The Occupational Safety, Health and Working Conditions (Central) Rules, 2026

Rule Form XXIII Form XXIII

FORM-XXIII Seal and Signature of Contractor (See rule 100) EXPERIENCE CERTIFICATE OF CONTRACT LABOUR To whomsoever it may concern

1. Name of contractor/employer*:

2. LIN/PAN No. of the contractor/employer *:

3. Email Id of the contractor /employer *:

4. Mobile No. of the contractor/employer *:

5. Nature and location of work:

6. Name of principal employer*:

7. LIN/PAN No. of the principal employer :*

8. Email Id of the principal employer : *

9. Mobile No. of the principal employer :*

10. Name of the labourer*:

11. UAN / Aadhaar No.:

12. Mobile No. :

13. Serial Number in the employee register :

14. Registration number, date and name of the Board where the building or other construction work is registered as a beneficiary:

15. Period of employment:

16. Designation:

17. Work performed:

*Strike off whichever is not applicable.