Prescribed Form

Form X — Appellate Medical Board examination certificate

Form-level filing, reconciliation and evidence guide.

Prescribed instrument: Annexure VII to the OSHWC Central Rules, 2026. Verify the current electronic filing mode and competent authority before submission.

Purpose and filing control

Form

Form X

Purpose

Appellate Medical Board examination certificate

Referenced by

Rule 119

Owner

Employer, contractor, manager, authorised signatory or competent authority according to the form

Submission mode

Electronic portal where prescribed; retain generated acknowledgement and signed source data

Source review

2026-07-17

Preparation checklist

Use the Gazette format and do not omit mandatory fields merely because a portal screen differs.
Reconcile identity, establishment, worker, wage, safety and licence data to source systems.
Attach supporting evidence and preserve the maker-checker approval.
Record submission time, transaction ID and authority acknowledgement.
Correct errors through the authorised amendment route rather than overwriting the original filing.

Linked Rules

Rule 119Standard and report of medical re-examination by the appellate medical board

Evidence file

Completed form/export
Source-data reconciliation
Attachments and authorisation
Portal transaction and acknowledgement
Correction or amendment history

Official source

Annexure VII — official GazetteForm X: Appellate Medical Board examination certificate