Rule 69: Manner of determining misuse of any benefit by an establishment or by any other person under section 148
Reviewed by Finin2min Editorial Desk · Last reviewed 7 September 2026
Rule 69 — Governs manner of determining misuse of any benefit by an establishment or by any other person under section 148 and the rights, duties, powers or procedure expressly stated in this rule. Key operative text: On the recommendations of the authority or the competent authority or Social Security Organisation, if the Central Government is satisfied that any establishment or any person has misused any benefit provided under the Code or…
Full notified rule textG.S.R. 344(E), 8 May 2026Source checked: 20 August 2026
Rule status
Social Security (Central) Rules, 2026 were finally notified under G.S.R. 344(E), 8 May 2026. The Central Rules must be read with the Code and any later amendment/corrigendum.
Official Gazette
2-minute answer
Rule 69: Manner of determining misuse of any benefit by an establishment or by any other person under section 148 should be read as an operative legal provision, not just a heading. Use the statutory text, effective-date/amendment status, connected rules/forms and the factual checklist below before applying it.
What this page answers
- Finin2min analysis — operative rule mechanics
- Operative clauses
- Provisos / explanations
- Thresholds & timelines
- Mapped Code sections
Practical checklist
- Read the operative text and amendment/effective-date status first.
- Map the provision to connected rules, forms, notifications and exceptions.
- Apply the provision to the actual facts rather than relying on the section heading alone.
- Keep the document trail that proves dates, amounts, approvals and compliance steps.
Related Finin2min guidance
Finin2min analysis — operative rule mechanics
Operative clauses
- On the recommendations of the authority or the competent authority or Social Security Organisation, if the Central Government is satisfied that any establishment or any person has misused any benefit provided under the Code or these rules, the Central Government may by notification, deprive such establishments or such person, as the case may be, from such benefit for such time as may be specified in the notification:
- Provided that no such order shall be passed unless an opportunity of being heard is given to such establishment or such person, as the case may be. ***** FORM- I [See rule 13 (2)(a)] APPEAL UNDER SECTION 23 OF THE CODE ON SOCIAL SECURITY, 2020 Title of the case:
- In the event of appeal being sent by speed post (with registration), it may be stated whether the appellant desires to have oral hearing at the admission stage and if so, he shall attach a self-addressed Post Card, Inland Letter, at which intimation regarding the date of hearing could be sent tohim. 12.
- (Give here name or description of the establishment with full address) I, Shri/Shrimati/Kumari…………………………………(Name in full here)whose particulars are given in the statement below, hereby nominate the person(s) mentioned below/ have acquired a family within the meaning of clause (33) of section 2 of the Code on Social Security, 2020 (36 of 2020) with effect from the …………………(date here) in the manner indicated below…
- I hereby declare that I have no family within the meaning of clause (33) of section 2 of the said Code. 3 (a) My father/mother/parents is/are not dependent on me.
Provisos / explanations
- Provided that no such order shall be passed unless an opportunity of being heard is given to such establishment or such person, as the case may be. ***** FORM- I [See rule 13
- Provided that where a woman dies during the period for which maternity benefit is payable, to her, the benefit shall be payable only for the days up to and including the day of her death. However, where the woman having been delivered of a child, dies during her delivery or during the remaining period of maternity benefit leaving behind in either case…
- Provided that where the dismissal is for one or more of the following acts, the employer may, by order in writing communicate to the woman, deprive her of the maternity benefit or medical bonus or both- (i) wilful destruction of employer's goods or property; (ii) assaulting any superior or co-employee at the place of work; (iii) criminal offence…
- Provided that during inspection, the Inspector-cum-Facilitator may require the production of accounts, books, register and other documents maintained in electronic form or otherwise.
Thresholds & timelines
- Signature of the Employee FORM-IV [(See rule 33(1)] Application for gratuity by an Employee/nominee/legal heir (Strike out the words not applicable) To,…………………………………………………………………………… (Give here name or description of the establishment with full address) Sir/Madam, I, ………………………..(name of employee/nominee/legal heir) /nominee of late…………………………….(Name of the…
- (b)death of the aforesaid employee while in service/superannuation on………………after completion of…………..years of service/total disablement of the aforesaid employee due to accident or disease while in service with effect from the………… or;
- (c)death of aforesaid employee of your establishment while in service/superannuation on…………………………(date) without making any nomination after completion of ……………..years of service/total disablement of the aforesaid employee due to accident or disease while in service with effect from…………………… Necessary particulars relating to my appointment are given in the…
- Reasons (Here specify the reasons); or (b) *as required under sub-clause (i) of clause (a) of sub-rule (2) of rule 33 the Social Security (Central) Rules, 2026 that a sum of Rs. ………..(Rupees…………………) is payable to you as gratuity/as your share of gratuity in terms of nomination made by ………………..on …………………and……………recorded in this …………………as a legal heir…
- Total period of service of the employee concerned: ………………….years……………….. months.
Mapped Code sections
Full notified text — Rule 69
English rule text transcribed from the final official 2026 Gazette PDF; layout is normalised for web reading. The Gazette controls.
69. Manner of determining misuse of any benefit by an establishment or by any other person
under section 148.-On the recommendations of the authority or the competent authority or Social
Security Organisation, if the Central Government is satisfied that any establishment or any person has
misused any benefit provided under the Code or these rules, the Central Government may by
notification, deprive such establishments or such person, as the case may be, from such benefit for
such time as may be specified in the notification:
Provided that no such order shall be passed unless an opportunity of being heard is given to
such establishment or such person, as the case may be.
*****
FORM- I
[See rule 13 (2)(a)]
APPEAL UNDER SECTION 23 OF THE CODE ON SOCIAL SECURITY, 2020
Title of the case:
APPEAL
INDEX
Serial No. Description of documents relied Page No.
1.
2.
3.
4.
Signature of the Applicant
For use in Tribunal’s office
Date of filing (or) Date of receipt by post Registration
No.
Signature of Registrar
IN THE CENTRAL GOVERNMENT INDUSTRIALTRIBUNAL
BETWEEN
A.B. APPELLANT
Vs.
C.D. RESPONDENT
DETAILS OF APPEAL
1. Particulars of the Appellant:
i. Name of the appellant
ii. Office address
iii. Address for service ofnotices
2. Particulars of the Respondent:
i. Name of therespondent
ii. Office address
iii. Address for service ofnotices
3. Particulars of the order/notification against which appeal is made.- The appeal is against
the followingorder/notification
i. Order/notification No. with reference to Annexure
ii. Date
iii. Passed by
iv. Subject inbrief
4. Jurisdiction of the Tribunal.- The appellant declares that the subject of the matter against
which he wants redressal is within the jurisdiction of theTribunal.
5. Limitation. —The appellant further declares that the appeal is within the limitation specified
in section 126 of the Code on Social Security, 2020 (36 of 2020).
6. Facts of the case.- The facts of the case are given below:
(Give here a concise statement of facts in a chronological order, each paragraph
containing as nearly as possible a separate issue, fact or otherwise)
7. Details of remedies exhausted. —The appellant declares that he has availed of all the
remedies available to him under the Code.
(Give here chronologically the details of representations made and the outcome of
such representation with reference to the Annexure numbers).
8. Matters not previously filed or pending with any other Court. —The appellant further
declares that he had not previously filed any appeal, writ petition or suit regarding the matters
in respects of which this appeal has been made, before any court of law or any other authority
or any other bench of the Tribunal nor any such appeal, writ petition or suit is pending before
any ofthem.
In case the appellant has previously filed any appeal, writ petition or suit, the
stage at which it is pending and if decided, the gist of the decision should be given
with reference to the Annexure.
9. Relief(s) sought. —In view of the facts mentioned in para 6 above, the appellant prays for the
following relief(s):--
[Specify below the relief(s) sought explaining the ground for relief(s) and the legal
provisions (if any) relied upon].
10. Interim order, if any, prayed for. —Pending final decision on the appeal the applicant seeks
issue of the following interim order—
(Give here the nature of the interim order prayed for with reasons)
11. In the event of appeal being sent by speed post (with registration), it may be stated whether
the appellant desires to have oral hearing at the admission stage and if so, he shall attach a
self-addressed Post Card, Inland Letter, at which intimation regarding the date of hearing
could be sent tohim.
12. Particulars of Bank Draft or Postal order in respect of the Appeal Fee:
13. Name of the Bank on which drawn
14. Demand Draft No. (OR)
15. Details of online fund transfer
16. List ofenclosures
1.
2.
3.
4.
5.
6.
VERIFICATION
I, ………………………… (Name of the Appellant) S/O, D/O, W/O …………………..
Age…………. working as ………..in the office of …………………. resident of …………. do
hereby verify that the contents of paras ………. to……………. are true to my personal knowledge
and paras …….. to………. believed to be true on legal advice and that I have not suppressed any
material fact.
Signature of the Appellant
Date:
Place:
To
The Registrar
FORM-II
[See rule 13 (2)(c)]
RECEIPT SLIP
Receipt of the appeal filed in the Central Government Industrial Tribunal at ……………. by
Sri/Smt/Kum………………………… working in/for………………… of…………… residing
at………………………………………. is hereby acknowledged.
For Registrar
Central Government Industrial
Tribunal
Date:
Seal:
FORM-III
[(See rules 32 (1),(2), (3) and (4)]
[For the purpose of Chapter-V]
Nomination/Fresh Nomination/Modification of Nomination
(Strike out the words not applicable)
Sl. No. Details of the employee:
1. Name of employee in full
2. Father‘s/Spouse‘s name
3. Date of Birth (- -/- -/- - - -)
4. Universal Account Number(if available):
5. Sex
6. Religion
7. Whether unmarried/married/widow/widower
8. Department/Branch/Section where employed
9. Post held with Ticket No. or Serial No., if any
10. Date of appointment
11. Date of superannuation
12. Permanent address:
Village:
Post-Office:
Thana:
Sub-Division:
District:
State:
Pin-Code:
E-mail ID:
Mobile Number:
To………………………………………………………………………………………………………
……………..
(Give here name or description of the establishment with full address)
I, Shri/Shrimati/Kumari…………………………………(Name in full here)whose particulars are
given in the statement below, hereby nominate the person(s) mentioned below/ have acquired a family
within the meaning of clause (33) of section 2 of the Code on Social Security, 2020 (36 of 2020) with
effect from the …………………(date here) in the manner indicated below and therefore nominate
afresh the person(s) mentioned below to receive the gratuity payable after my death as also the
gratuity standing to my credit in the event of my death before that amount has become payable, or
having become payable has not been paid and direct that the said amount of gratuity shall be paid in
proportion indicated against the name(s) of the nominee(s).
or
I, Shri/Shrimati/Kumari……………………………(Name in full here) whose particulars are given in
the statement below, hereby give notice that the nomination filled by me on date ………… and
recorded under your reference No…………….dated………………. shall stand modified in the
following manner:-
*Strike out unnecessary portion.
Nominee(s)
S.No. Name in full with full Relationship Age of Aadhaar No. of the Proportion by
address of with nominee nominee which
nominee(s) the employee the gratuity will be
shared
1.
2.
3.
So on
DECLARATION
1. I hereby certify that the person(s) mentioned is/are a member(s) of my family within the meaning of
clause (33) of section 2 of the Code on Social Security, 2020 (36 of 2020).
2. I hereby declare that I have no family within the meaning of clause (33) of section 2 of the said
Code.
3 (a) My father/mother/parents is/are not dependent on me.
(b) My husband's father/mother/parents is/are not dependent on my husband.
4. I have excluded my husband from my family by a notice dated the……………… to the competent
authority in terms of clause (33) of section 2 of the said Code.
5. Nomination made herein invalidates my previous nomination.
Manner of acquiring a ―Family‖
(Here give details as to how a family was acquired, i.e., whether by marriage or parents being
rendered dependent or through other process like adoption)
Place:
Date:
Signature/Thumb-impression of the Employee
Certificate by the Employer
Certified that the particulars of the above nomination have been verified and recorded in this
establishment.
Employer's Reference No., if any
Signature of the employer/Officer authorised
Designation
Date: Name and address of the establishment
or
rubber stamp thereof.
Acknowledgement by the Employee
Received the duplicate copy of nomination in Form-III filed by me and duly certified by the
employer.
Date: ………………….
Signature of the Employee
FORM-IV
[(See rule 33(1)]
Application for gratuity by an Employee/nominee/legal heir
(Strike out the words not applicable)
To,……………………………………………………………………………
(Give here name or description of the establishment with full address)
Sir/Madam,
I, ………………………..(name of employee/nominee/legal heir) /nominee of
late…………………………….(Name of the employee)/ as a legal heir of
late…………………………….(Name of the employee), want to apply for payment of gratuity to
which I am entitled under sub-section (1) of section 53 of the Code on Social Security, 2020 (36 of
2020) on account of-
(a) my superannuation/retirement/resignation after completion of not less than five years of
continuous service/total disablement due to accident/total disablement due to disease/ on
termination of contract period under fixed term employment with effect from
the…………………..or;
(b)death of the aforesaid employee while in service/superannuation on………………after
completion of…………..years of service/total disablement of the aforesaid employee due to
accident or disease while in service with effect from the………… or;
(c)death of aforesaid employee of your establishment while in service/superannuation
on…………………………(date) without making any nomination after completion of
……………..years of service/total disablement of the aforesaid employee due to accident or
disease while in service with effect from……………………
Necessary particulars relating to my appointment are given in the statement below.
1. Name of employee in full, (if the gratuity is claimed by an employee)
a. Marital status of employee(unmarried/married/widow/widower)
b. Address in full of employee
or
2. Name of nominee/legal heir, (if the gratuity is claimed by nominee/legal heir)
a. Name of Employee
b. Marital status of nominee/legal heir(unmarried/married/widow/widower)
c. Relationship of nominee/legal heir with the employee
d. Address in full of nominee/legal heir
e. Date of death and proof of death of the employee
f. Reference No. of recorded nomination, if available
3. Department/Branch/Section where last employed
4. Post held by employee.
5. Date of appointment.
6. Date and cause of termination of service
7. Date of Death
8. Total period of service of the employee
9. Total wages last drawn by the employee.
10. Total gratuity payable to the employee/ share of gratuity claimed by a nominee/legal heir.
11. Payment may please be made by crossed bank cheque/credit in my bank account no…...
Yours faithfully,
Signature/Thumb-impression of the
applicant employee/nominee/legal heir.
Place:
Date:
FORM-V
[(See rule 33(2)]
Notice for payment/rejecting claim of gratuity
(Strike out the words not applicable)
To,………………………………………………………………………………………………………
……………………………….
(Name and address of the applicant employee/nominee legal heir)
You are hereby informed that
(a) *as required under sub-clause (ii) of clause (a) of sub-rule (2) of rule 33 of the Social Security
(Central) Rules, 2026, that your claim for payments of gratuity as indicated on your application in
Form-IV under the said rules is not admissible for the reasons stated below:
Reasons (Here specify the reasons); or
(b) *as required under sub-clause (i) of clause (a) of sub-rule (2) of rule 33 the Social Security
(Central) Rules, 2026 that a sum of Rs. ………..(Rupees…………………) is payable to you as
gratuity/as your share of gratuity in terms of nomination made by ………………..on
…………………and……………recorded in this …………………as a legal heir
of………………….an employee of this establishment.
2.*Please call at ……………………..on………………………… (Here specify
place)……………………..(date) at……………….(time) for collecting your payment of
gratuity crossed cheque.
3. Amount payable shall be sent to you through demand draft or shall be credited in your bank
account as desired by you.
4. Brief statement of calculation
a. Date of appointment.
b. Date of termination/superannuation/resignation/ disablement/death.
c. Total period of service of the employee concerned: ………………….years………………..
months.
(d) Wages last drawn:
(e) Proportion of the admissible gratuity payable in terms of nomination/as a legal heir:
(f) Amount payable:
*strike out para, if not applicable
Place:
Date: Signature of the Employer/Authorised Officer.
Name or description of establishment or
rubber stamp thereof.
Copy to:
The Competent Authority.
FORM-VI
[(See rule 33(4)]
Application for Direction
Before the Competent Authority for Chapter V under the Code on Social Security, 2020
Application No. Date
BETWEEN
(Name in full of the applicant with full address)
AND
(Name in full of the employer concerned with full address)
The applicant is an employee of the above-mentioned employer/a nominee of
late………………………… an employee of the above-mentioned employer/a legal heir of
late………………………… and employee of the above-mentioned employer, and is entitled to
payment of gratuity under section 53 of the Code on Social Security, 2020 (36 of 2020) on account of
his own/aforesaid employee's superannuation on……………………………(date)/his own
retirement/aforesaid employees' resignation on…………………..(date) completion
of…………………years of continuous service/his own/aforesaid employees' total disablement with
effect from ………………….(date)due to accident/disease death of aforesaid employee
on……………….
2. The applicant submitted an application under rule…………………… of the Social Security
(Central) Rules, 2026 on the ……………….but the above-mentioned employer refused to entertain
it/issued a notice dated the……………. under clause ………….of sub-rule of rule
……………….offering an amount of gratuity which is less than my due/issued a notice dated the
……………….. under clause…………. of sub-rule…………of rule………………. rejecting my
eligibility to payment of gratuity. The duplicate copy of the said notice is enclosed.
3. The applicant submits that there is a dispute on the matter (specify the dispute).
4. The applicant furnishes the necessary particulars in the annexure hereto and prays that the
Competent Authority may be pleased to determine the amount of gratuity payable to the applicant and
direct the above-mentioned employer to pay the same to the applicant.
5. The applicant declares that the particulars furnished in the annexure hereto are true and correct to
the best of his knowledge and belief.
Place:
Date:
Signature/Thumb impression of the applicant.
ANNEXURE
1. Name in full of applicant with full address
2. Basis of claim (Death/Superannuation/Retirement/Resignation/Disablement of
Employee/Completion of contract period under Fixed Term Employment)
3. Name and address in full of the employee
4. Marital status of the employee (unmarried/married/widow/widower)
5. Name and address in full of the employer
6. Department/Branch/Section where the employee was last employed (if known)
7. Post held by the employee with Ticket or Sl. No., if any (if known)
8. Date of appointment of the employee (if known)
9. Date and cause of termination of service of the employee (Superannuation / retirement / resignation
/disablement / death/Completion of contract period under fixed term employment)
10. Total period of service by the employee
11. Wages last drawn by the employee
12. If the employee is dead, date and cause thereof
13. Evidence/witness in support of death of the employee
14. If a nominee, No. and date of recording of nomination with the employer
15. Evidence/witness in support of being a legal heir, if a legal heir
16. Total gratuity payable to the employee (if known)
17. Percentage of gratuity payable to the applicant as nominee/legal heir
18. Amount of gratuity claimed by the applicant
Place:
Date: Signature/Thumb-impression of the applicant
FORM – VII
[(See rules 33 (5) and (8)]
Notice for Appearance before the Competent Authority/Summon
(Strike out the words not applicable)
To,
(Name and address of the employer/applicant)
Whereas Shri/Smt/Kumari …………………………..an employee under youor a nominee(s)or legal
heir(s) of Shri/Smt/Kumari………………………………….an employee under the above-mentioned
employer, has/have filed an application under sub-rule (4) of rule 33 of the Social Security(Central)
Rules, 2026 alleging that----
(A copy of the said application is enclosed, if summon is issued then copy of application is not
required)
Now, therefore, you are hereby called upon/summoned to appear before the Competent Authority at
…………………..(place)either personally or through a person duly authorised in this behalf for the
purpose of answering all material questions relating to the application on the ….. day of
…………20….. at …………….'O' clock in the forenoon/afternoon in support of/to answer the
allegation; and as the day fixed for your appearance is appointed for final disposal of the application,
you must be prepared to produce on that day all the witnesses upon whose evidence, and the
documents upon which you intend to rely in support of your allegation/defence.
Take notice that in default of your appearance on the day before-mentioned, the application will be
dismissed/heard and determined in your absence.
Whereas your attendance is required to give evidenceor you are required to produce the documents
mentioned in the list below, on behalf of ……….. in the case arising out of the claim for gratuity
by………. Form………….. and referred to this Authority by an application under section 56 of the
Code on Social Security, 2020 (36 of 2020), you are hereby summoned to appear personally before
this Authority on the ……. day of ……..20…………….. at ………… ‗O‘clock in the
forenoon/afternoon and to bring the said documents with you.
List of documents-
1.
2.
3. so on
Given under my hand and seal, this …………..day of …………..20…..
Competent Authority
under the Code on Social Security Code, 2020
Note: 1. Strike out the words and paragraphs not applicable.
2. The portion not applicable to be deleted.
3. The summons shall be issued in duplicate. The duplicate is to be signed and returned by the
persons served before the date fixed.
4.In case the summons are issued only for producing a document and not to given evidence it will
be sufficient compliance to the summons if the documents are caused to be produced before the
Competent authority on the day and hour fixed for the purpose.
FORM – VIII
[(See rules 33(11) and 33(12)(h)]
Notice for payment of gratuity as determined by Competent/Appellate Authority
(Strike out the words not applicable)
To,
(Name and address of employer)
Whereas Shri/Smt./Kumari…………………………………… an
employee…………………………………………………… (address)under you/a nominee(s)/legal
heir(s) of late ………………………………………………an employee under you, filed an
application under section 56 of the Code on Social Security, 2020 (36 of 2020), before me; or
Whereas a notice was given to you on …………………….requiring you to make payment of
Rs…………………… to Shri/Smt./Kumari………………………………as gratuity under the Code
on Social Security, 2020 (36 of 2020).
And whereas the application was heard in your presence on………..and after the hearing have come
to the finding that the said Shri/Smt./Kumari………………………………………… is entitled to a
payment of Rs……………… as gratuity under the Code on Social Security, 2020 (36 of 2020); or
Whereas you or the applicant went in appeal before the appellate authority, who has decided that an
amount of Rs………………….. is due to be paid to Shri/Smt./Kumari………………………….as
gratuity due under the Code on Social Security, 2020 (36 of 2020).
Now, therefore, I hereby direct you to pay the said sum of Rs. ……………………….to
Shri/Smt./Kumari ………………………………. within thirty days of the receipt of this notice with
an intimation thereof to me.
Given under my hand and seal, this …………….day of……………….20………...
Competent Authority
under the Code on Social Security Code, 2020
Copy to:
1. The Applicant- He is advised to contact the employer for collecting payment.
2. The Appellate Authority if applicable.
Note.--- (Strike out paragraphs if not applicable)
FORM – IX
[(See rule 33 (13)]
Application for Recovery of Gratuity
Before the Competent Authority for Chapter V under the Code on Social Security, 2020
Application No. Date
BETWEEN
(Name in full of the applicant with full address)
AND
(Name in full of the employer/Trust/Insurer concerned with full address)
1. The applicant is an employee of the above-mentioned employer/a nominee of
late……………………
an employee of the above mentioned employer/a legal heir of late ………………an employee of the
above-mentioned employer, and you were pleased to direct the said employer in your notice dated the
………………………..under sub-rule (11) or sub-rule (12) of rule 33 of Social Security (Central)
Rules, 2026for payment of a sum of Rs………………….. as gratuity payable under the Code on
Social Security, 2020 (36 of 2020).
2. The applicant submits that the said employer failed to pay the said amount of gratuity to me as
directed by you although I approached him for payment.
3. The applicant therefore prays that a certificate may be issued under section 129 for recovery of the
said sum of Rs. ……………………….due to me as gratuity in terms of your direction.
Signature/Thumb-impression of applicant.
Place:
Date:
Note.—Strike out the words not applicable.
FORM – X
[See rule 35(1)(a), 35(1)(d) and 35(2)(f)]
Certificate of Medical Officer/Medical Practitioner for confinement/miscarriage/ Medical
termination of pregnancy or tubectomy operation/ delivery of a child
This is to certify that-
1. *I examined…….wife/ daughter of ….. a woman employee in…… (Name of the
establishment) on…... (Date) and found/ cannot discover that she is pregnant and is expected
to be delivered of a child within (month and/days) from the above mentioned date or has
undergone miscarriage/ Medical termination of pregnancy or tubectomy operation/has been
delivered of a child on……… (Date) or is suffering from………(date) from illness arising out
of pregnancy or delivery or premature birth of a child or miscarriage/ Medical termination of
pregnancy or tubectomy operation.
2. *Smt……… wife/daughter of……… employed in…… (Name of the establishment) expired
on ……before/during/ after confinement. The child died on……or survives her.
3. *I examined….wife/ daughter of….a woman employed in………… (Name of establishment)
and found that she has been delivered of a child or has undergone miscarriage on………
(date).
*Strike out unnecessary portion.
Signature and designation of
Medical Officer/Medical Practitioner/ASHA/ANM/Gram Pradhan/Village Administrative Officer/
Authorised Officer of the Municipality
Date………
Definitions of "child" and "miscarriage" as in the Code on Social Security, 2020(36 of 2020).-
1. "Child" includes a still-born child.
2. "Miscarriage" means expulsion of the contents of a pregnant uterus at any period prior to or
during the twenty-sixth week of pregnancy but does not include any miscarriage, the causing of which
is punishable under the Indian Penal Code.
FORM – XI
[See rule 35 (2)(a) and (c)]
(Notice of claim for maternity benefit and payment thereof under sections 62 and 63)
To
……………….… (name of establishment)
PART I
[See Rule 35 (2)(a)]
Notice
I …………. (name of woman) wife or daughter of…… employed as…… at………(name of
establishment), hereby give notice that I expect to be confined within six weeks next following from
the date of this notice or have given birth to a child on…..(date) and shall be absent from work
from…..(date). I shall not work in any establishment during the period for which I receive maternity
benefit.
2.For the purpose of section 63, I hereby nominate……… (Here enter name and address of the
nominee) to receive maternity benefit and/ or any other amount due to me under the Code in case of
my death.
Signature of an Attester in case Signature or thumb impression of woman
the woman is not able to sign
and affix thumb impression.
Date…………
PART II
[See rule 35 (2)(c)]
FORM OF RECEIPT OF MATERNITY BENEFIT
I,……, the undersigned, a woman employee/ the nominee of…… woman employee or legal
representative of…… woman employee deceased in……(name of establishment) at…… in……
district received maternity benefit and/or other amount due under the Code on Social Security
,2020(36 of 2020) from the employer of the establishment referred to above, as detailed below:-
Rs…… being the first installment of maternity benefit paid on……
Rs…… being the second installment of maternity benefit after delivery paid on……
Rs…… being the medical bonus under section 64 of the Code paid on……
Rs……being the wages for the leave period from…… to…… mentioned under section 65.
*My/ Her confinement/ miscarriage or Medical termination of pregnancy or tubectomy operation
took place on…….or I/she fell ill because of pregnancy, delivery, premature birth of a child or
miscarriage or Medical termination of pregnancy or tubectomy operation on………… In consequence
I…… her nominee/legal representative has received the aforesaid amounts prescribed in sections 60,
64 and 65 of the Code on Social Security, 2020(36 of 2020).
Signature or thumb impression of………
*Woman employee or her nominee or legal representative
Signature of an Attester in case the woman is not able to sign
and affixes thumb impression
Place:
Date:
*Strike out unnecessary portion.
Form XII
[seerule 38 (2)]
Appeal under Section 68
To
The Competent Authority
(Appointed under Chapter VI of Code on Social Security, 2020)
……..(Address)
Sir,
I, ..…. The undersigned, woman employee of ….(name and full address of the establishment)
have been wrongly deprived by the employer of maternity benefit or medical bonus or both or
wrongly discharged or dismissed during or on account of absence from work in accordance with the
provisions of Chapter VI of the Code on Social Security, 2020(36 of 2020) for the reasons attached
hereto, prefer this appeal under sub-section (2) of section 68 and request that the said employer be
ordered to pay the above mentioned amount to me and/or set aside the order of discharge/dismissal. A
copy of the order of the employer in this behalf is enclosed.
Signature or thumb impression of the Woman employee/
nominee/ legal representative
Place...........
Date…………
Signature of an Attester in case the woman employee/
nominee/ legal representative is
unable to sign and affixes thumb impression.
Full address of the woman employee /nominee/legal representative.
FORM – XIII-A
[See rule 39(1)(a)]
Complaint to the Inspector-cum-Facilitator
To,
The Inspector-cum-Facilitator
(under the Code on Social Security, 2020)
Sir,
I…… (Name of woman employee) employed in…… (name and full address of the
establishment) or I……, (name), a person nominated under section 62 by or a legal representative
of……(name of woman employee) employed in…….(name and full address of the establishment)
having fulfilled the conditions laid down in the Code on Social Security, 2020(36 of 2020) and the
rules framed thereunder, am entitled to Rs…… being maternity benefit and/ or Rs…… being the
medical bonus and/ or Rs………. being wages for leave due under section 65 but the same has been
improperly withheld by the employer/discharged or dismissed during or on account of my/her absence
from work in accordance with the provisions of Chapter VI of Code on Social Security, 2020(36 of
2020).
You are, therefore, requested to direct the employer to pay the amount to me and/or to set
aside the discharge or dismissal done by the employer.
Signature or thumb impression of the Woman employee/
nominee/ legal representative
Place.............
Date…………
Signature of an Attester in case the woman employee/
nominee/ legal representative is
unable to sign and affixes thumb impression.
Full address of the woman employee/nominee/legal representative.
FORM-XIII-B
[See rule 39 (2) (b)]
Appeal
To,
The Appellate Authority,
(Appointed under the Code on Social Security, 2020)
……………………………………………(Address)
Sir,
I………, the undersigned, woman employee/her legal heir/her representative or employer/his
representative of……… (name and full address of the establishment) aggrieved by the order of
Inspector-cum-Facilitator Shri…….. hereby prefer this Appeal under sub-section (3) of section 72 in
view of the facts mentioned in the memorandum and other documents filed herewith.
*Denial by his order under sub-section (2) of section 72, the maternity benefit or other amount
……… (Nature of amount) to which……… (Name of woman employee) is entitled and/or refused to
set aside discharge or dismissal of …….. (Name of woman employee) during or on account of
absence from work in accordance with the provisions of Chapter VI of the Code on Social Security,
2020(36 of 2020)(Strike out unnecessary portion).
*It is submitted that the ……….. (Name of woman employee) is not entitled to the maternity benefit
or the said amount and/or rightly discharged or dismissed hence the order of the Inspector-cum-
Facilitator may be set aside.
*Strike out unnecessary portion.
Signature or thumb impression of the Woman employee/Aggrieved person/Employer
Place.............
Date………
…………………………………………………………………..
Signature of an Attester in case the woman employee is
not able to sign and affixes thumb impression.
Full address of the nominee/legal representative
FORM – XIV
[See rule 40(4)]
(Abstract for the Maternity Benefit, and the rules made under the Code on Social Security,
2020).
1. No employer shall knowingly employ a woman during the six weeks immediately following
the day of her delivery/miscarriage/Medical termination of pregnancy and no woman shall work in
any establishment during the said period.
2. No pregnant woman shall, on a request being made by her in this behalf, be required by her
employer to do during the period of one month immediately preceding the period of six weeks before
the date of her expected delivery and also for any period during this period of six weeks for which she
does not avail of leave of absence, any work which is of an arduous nature or which involves long
hours of standing, or which in way is likely to interfere with her pregnancy or the normal development
of the foetus, or is likely to cause her miscarriage or otherwise to adversely affect her health.
3. (a) Subject to the provisions of the Code, every woman who has actually worked in an
establishment of the employer from whom she claims maternity benefit for a period of not less than
eighty days, including the days during which she was laid off, shall be entitled to, and her employer
shall be liable for, the payment of maternity benefit at the rate of her average daily wages, or the
minimum rate of wage fixed or revised under the Code on Wages, 2019 (29 of 2019) or two hundred
rupees a day, whichever is higher, for the period of her actual absence not exceeding six weeks
immediately preceding the day of delivery and the remaining period immediately following that day:
Provided that where a woman dies during the period for which maternity benefit is payable,
to her, the benefit shall be payable only for the days up to and including the day of her death.
However, where the woman having been delivered of a child, dies during her delivery or during the
remaining period of maternity benefit leaving behind in either case the child, the employer shall be
liable for the payment of maternity benefit for the entire period of maternity benefit following the day
of her delivery but if the child also dies during the said period, then, for the days up to and including
the day of the death of the child.
(b)The amount of maternity benefit for the period preceding the date of her expected delivery shall be
paid in advance by the employer to the woman on production of a certificate in Form-X stating that
she is pregnant and is expected to be delivered of a child within six weeks of the date of production of
the certificate, and the amount due for the subsequent period shall be paid by the employer to the
woman within forty-eight hours of production of the certificate in Form-X stating that she has been
delivered of a child or production of a certified extract from a Birth Register maintained under the
provisions of any law for the time being in force.
4. (a) Any woman employed in an establishment and entitled to maternity benefit under the
provisions of the Code may give notice in writing in Form-XI to her employer, stating that her
maternity benefit and any other amount to which she may be entitled under the Code may be paid to
her or to such person as she may nominate in the notice and that she will not work in any
establishment during the period for which she receives maternity benefit.
(b) In the case of a woman who is pregnant, such notice shall state the date from which she will
be absent from work, not being a date earlier than six weeks from the date of her expected delivery.
(c) Any woman who has not given the notice when she was pregnant may give such notice as
soon as possible after the delivery.
(d) On receipt of the notice, the employer shall permit such woman to absent herself from
establishment until the expiry of the remaining period of maternity benefit after the day of her
delivery.
5. (a)Every woman entitled to maternity benefit under the Code shall also be entitled to receive
from her employer a medical bonus of rupees three thousand and five hundred, if no pre-natal,
confinement and post-natal care is provided for by the employer free of charge. The medical bonus
shall be paid along with the second installment of the maternity benefit.
(b)In case of miscarriage/medical termination of pregnancy, a woman shall, on production of a
certificate in Form-X be entitled to leave with wages at the rate of maternity benefit, for a period of
six weeks immediately following the day of her miscarriage. The wages shall be paid within 48 hours
of production of the certificate in Form-X.
(c)A woman suffering from illness arising out of pregnancy, delivery, premature birth of child or
miscarriage/ medical termination of pregnancy or tubectomy operation shall, on production of a
certificate in Form-X, be entitled, in addition to the period of absence allowed to her on account of
maternity or miscarriage/ medical termination of pregnancy or tubectomy operation, as the case may
be, to leave with wages at the rate of maternity benefit for a maximum period of one month. The
wages for the leave period shall be paid within 48 hours of the expiry of that period.
6. Every woman delivered of a child who returns to duty after such delivery shall, in addition to the
interval for rest allowed to her, be allowed in the course of her daily work two breaks of 15 minutes'
duration for nursing the child until the child attains the age of fifteen months. An extra sufficient
period, depending upon the distance to be covered, shall be allowed for the purpose of the journey to
and from the creche or the place where the children are left by women while on duty, provided that
such extra period shall be upto 15 minutes.
7. (1) When a woman absents herself from work in accordance with the provisions of the Code,
it shall be unlawful for her employer to discharge or dismiss her during or on account of such absence
or to give notice of discharge or dismissal on such a day that the notice will expire during such
absence, or to vary to her disadvantage any of the conditions of her service.
(2) (a) The discharge or dismissal of a woman at any time during her pregnancy, if the woman but for
which discharge or dismissal would have been entitled to maternity benefit or medical bonus shall not
have the effect of depriving her of the maternity benefit or medical bonus:
Provided that where the dismissal is for one or more of the following acts, the employer may,
by order in writing communicate to the woman, deprive her of the maternity benefit or medical bonus
or both-
(i) wilful destruction of employer's goods or property;
(ii) assaulting any superior or co-employee at the place of work;
(iii) criminal offence involving moral turpitude resulting in conviction in a Court of law;
(iv) theft, fraud, or dishonesty in connection with the employer's business or property; and
(v) wilful non-observance of safety measures or rules on the subject or wilful interference with
safety devices or with fire-fighting equipment.
(b) Any woman deprived of maternity benefit or medical bonus or both, may within sixty days
from the date on which the order of such deprivation is communicated to her, appeal in Form-XII to
the Competent Authority and his decision on such appeal whether the woman should or should not be
deprived of maternity benefit or medical bonus or both, shall be final.
8. If a woman works in any establishment after she has been permitted by her employer to absent
herself under the provisions of the Code, she shall forfeit her claim to the maternity benefit for such
period.
9. (1) Any woman claiming the maternity benefit or any other amount to which she is entitled
under the Code and any person claiming that payment due has been improperly withheld may make
complaint to the Inspector-cum-Facilitators in writing in Form-XIII-A.
(2)The Inspector-cum-Facilitators may, on his own motion or on receipt of a complaint in Form-
XIII-A, make an inquiry or cause an enquiry to be made and if satisfied that payment has been
wrongfully withheld, may direct the payment to be made in accordance with his orders.
(3) Any person aggrieved by the decision of the Inspector-cum-Facilitator may, within, thirty days
from the date on which such decision is communicated to such person, appeal in Form-XIII-B to the
Authority prescribed by the appropriate Government.
(4)The decision of Authority where an appeal has been preferred to him or of the Inspector-cum-
Facilitator where no such appeal has been preferred, shall be final.
10. (a)The employer shall supply to every woman employed by him at her request free of cost
copies of Forms X, XI, XII, XIII-A and XIII-B.
(b)The failure to submit a notice, appeal or complaint in the prescribed form shall not affect the right
of a woman entitled to receive maternity benefit or any other amount due under the Code. Where a
notice, appeal or complaint has been received in a form other than the prescribed form, the authority
concerned shall within fifteen days of the receipt of such notice, appeal or complaint, require the
woman to submit the notice, appeal or complaint, as the case may be in the prescribed form.
11. (a) (1) The employer of the establishment in which women are employed shall prepare and
maintain a register of women employees in Form-XXII and shall enter therein particulars of all
women employees in the establishment.
(2) All entries in the register of women employees shall be made in ink and maintained up-to-date and
it shall always be available for inspection by the Inspector-cum-Facilitator during working hours.
(b)The employer to which the Code applies, on or before the 28th/29th day of February in each year,
upload a unified annual return in Form-XXIII online on the web portal of the Central Government in
the Ministry of Labour and Employment, giving information as to the particulars specified, in respect
of the preceding year:
Provided that during inspection, the Inspector-cum-Facilitator may require the production of
accounts, books, register and other documents maintained in electronic form or otherwise.
Explanation.– The expression ―electronic form‖ shall have the same meaning as assigned to it
in clause (r) of section 2 of the Information Technology Act, 2000 (21 of 2000).
FORM – XV
[See rule 41(1)(a) and (b)]
Information for commencement or modification in respect of building or other construction
work by the employer
1. Name and address (permanent) of the establishment.
2. Name of the employer and address details
3. Name and address/ location of place where the building
or other construction is proposed to be carried on.
4. Name, designation and address of the authorised Person
along with contact details
5. Correspondence address for the proposed building or
other construction work
6. Nature of proposed construction work
7. Date of commencement of work(in case construction
has started)
8. Approximate duration of work
9. Details of any change /modifications in the proposed
construction work
Declaration
I/we hereby intimate that the building or other construction work (name of work) having
registration number ………………. dated ………………. is likely to commence or is likely to modify
with effect from (date)/ [on (date)].
Signature and Seal of
employer
Name:
Date:
Place:
Mobile Number:
E-mail (if any):
FORM – XVI
[See rule 41 (2)(b)]
Format for Self- assessment of Cess for building or other construction work to be furnished by
employer
1. Name and address (permanent) of the establishment.
2. Name of the employer and address details
3. Name and address or location of place where the
building or other construction work is proposed to be
carried on.
4. Name, designation and address of the authorised
Person along with contact details
5. Correspondence address for the proposed building or
other construction work
6. Nature of proposed construction work
7. Date of commencement of work(in case construction
has started)
8. Approximate duration of work
9. Total proposed area of construction work
10. Total estimated cost of the construction based on the
rates of (PWD or CPWD or RERA or some other
rates, as the case may be) along with documents
(original) as per Rule 41.
11 Total estimated cost of construction as certified by
chartered engineer
12 Amount of provisional cess %age of total estimated cost Total
of the construction as notified estimated
by the Central Government cess (in Rs.)
13 Advance cess paid, along with details (at the time of
approval of the Project or before the commencement
of the construction work) or deduction at source
14 Details of cess paid (when duration of the proposed
construction work is more than one year)
Sl Year Amount (in Rs.)
No
14.1 1st year
14.2 2nd Year
14.3 3rd Year
15 Total amount of the cess paid (Sl.No. 13 + 14)
Declaration
1. I/We hereby declare that the particulars given above are true to the best of my/our knowledge
and belief and I/We hereby declare that nothing has been concealed or any fact has been mis-
represented in the above calculation made by me/us.
2. I/We hereby declare that I/We am/are quite aware of the penal provisions of the Code on
Social Security, 2020(36 of 2020) and if in future anything mentioned in the above self-
assessment of cess amount, is found to be incorrect or inappropriate or any incidence of
hiding the facts or under calculation of cess amount is found, punitive action may be taken
against me/us.
Signature and seal of
employer
Name:
Date:
Place:
Mobile Number:
E-mail (if any):
Certified by Chartered Engineer
Along with his registration number, duly stamped.
FORM- XVII
[See rules 41(2) (e )and 41(5)(a)(b)(c)]
Notice for stoppage or reduction of Building or Other Construction Work
1. Name of Establishment
2. Registration number of Establishment
3. Address of establishment
4. Date of commencement of work DD MM YYYY
5. Approximate proposed period of work DD MM YYYY
6. Date of stoppage or reduction of the building or other
construction work
7. Total estimated cost of the construction based on the
rates of (PWD or CPWD or RERA or some other rates,
as the case may be) along with documents (original) as
per Rule 41.
8 Total incurred cost of the construction work
9 Total amount of cess payable %age of total incurred cost of Total cess
the construction as notified by payable (in
the Central Government Rs.)
10 Advance cess paid, along with details (at the time of
approval of the Project or before the commencement of
the construction work) /deduction at source, if any
11 Details of cess paid (when duration of the proposed
construction work was more than one year)
Sl. No. Year Amount (in Rs.)
11.1 1st year
11.2 2nd Year
11.3 3rd Year
12 Total amount of the cess paid (Sl.No. 10 + Sl.No 11)
13. Amount of outstanding cess (Sl.No. 9 – Sl.No.12)
14 Proof of payment of outstanding cess, if applicable
15. Amount of overpaid cess, if applicable
16. In case overpaid, details of the bank account in which
excess amount is to be refunded
17 Remarks, if any
Declaration
1. I/We hereby declare that the particulars given above are true to the best of my/our knowledge and
belief and I/We hereby declare that nothing has been concealed or any fact has been mis-represented
in the above calculation made by me/us.
2. I/We hereby declare that I/We am/are quite aware of the penal provisions of the Code on Social
Security, 2020(36 of 2020) and if in future anything mentioned in the above self-assessment of cess
amount, is found to be incorrect or inappropriate or any incidence of hiding the facts or under
calculation of cess amount is found, punitive action may be taken against me/us.
Signature and seal of
employer
Name:
Date:
Place:
Mobile Number:
E-mail (if any):
Certified by Chartered Engineer
Along with his registration number, duly stamped.
FORM- XVIII
[See rules 41 (2) (f) and 41(4) (a), (c) and (e)]
Return on completion of building or other construction work submitted by employer
1. Name and address (permanent) of the establishment
2. Name of the employer and address details
3. Name and address/ location of place where the building
or other construction is proposed to be carried on
4. Name, designation and address of the authorised
Person along with contact details
5. Correspondence address for the proposed building or
other construction work
6. Nature of proposed construction work
7. Date of commencement of work(in case construction
has started)
8. Date of completion of work
9. Duration of work
10. Total completed area of construction work
11. Total estimated cost of the construction based on the
rates of (PWD or CPWD or RERA or some other rates,
as the case may be) along with documents (original) as
per Rule 41
12 Total incurred cost of the construction work
13 Total amount of cess payable %age of total incurred cost of Total cess
the construction as notified by payable (in
the Central Government Rs.)
14 Advance cess paid, along with details (at the time of
approval of the Project or before the commencement of
the construction work) /deduction at source, if any
15 Details of cess paid (when duration of the proposed
construction work is more than one year)
Sl. No. Year Amount (in Rs.)
15.1 1st year
15.2 2nd Year
15.3 3rd Year
16 Total amount of the cess paid (Sl. No. 14 + Sl. No. 15)
17. Amount of outstanding cess (Sl. No. 13 – Sl. No.16)
18 Proof of payment of outstanding cess, if any
19. Amount of overpaid cess, if applicable
20. In case overpaid, details of the bank account in which
excess amount is to be refunded
21. Remarks, if any
Declaration
1. I/We hereby declare that the particulars given above are true to the best of my/our knowledge and
belief and I/We hereby declare that nothing has been concealed or any fact has been mis-represented
in the above calculation made by me/us.
2. I/We hereby declare that I/We am/are quite aware of the penal provisions of the Code on Social
Security, 2020 and if in future anything mentioned in the above self-assessment of cess amount, is
found to be incorrect or inappropriate or any incidence of hiding the facts or under calculation of cess
amount is found, punitive action may be taken against me/us.
Signature and seal of
employer
Name:
Date:
Place:
Mobile Number:
E-mail (if any):
Certified by Chartered Engineer
Along with his registration number, duly stamped.
FORM – XIX
[See rule 44(1)of the Social Security(Central) Rules, 2026 and section 105 of the Code on Social
Security, 2020)
Proforma for appeal before the Appellate Authority against Order of assessment or Order
imposing penalty
1 Name and address (permanent) of the establishment.
2 Name of the employer and address details
3 Name and address/ location of place where the building
or other construction is proposed to be carried on.
4 Name, designation and address of the authorised Person
along with contact details
5 Correspondence address for the proposed building or
other construction work
6 Nature of proposed construction work
7 Date of commencement of work(in case construction
has started)
8 Date of completion of work
9 Duration of work
10 Total completed area of construction work
11 Total estimated cost of the construction based on the
rates of (PWD or CPWD or RERA or some other rates,
as the case may be) along with documents (original) as
per Rule 41.
12 Total incurred cost of the construction work
13 Total amount of cess payable %age of total incurred cost of Total cess
the construction as notified by payable (in
the Central Government Rs.)
14 Advance cess paid, along with details (at the time of
approval of the Project or before the commencement of
the construction work) /deduction at source, if any
15 Details of cess paid (when duration of the proposed
construction work is more than one year)
Sl.No. Year Amount (in Rs.)
st
15.1 1 year
15.2 2nd Year
15.3 3rd Year
16 Total amount of the cess paid (Sl. No. 14 + Sl. No. 15)
17 Amount of outstanding cess (Sl. No. 13 – Sl. No.16)
18 Proof of payment of outstanding Cess, if any
19 Amount of overpaid cess, if applicable
20 Amount of cess assessed by the Assessing Officer
21 Amount of outstanding cess to be paid by the employer
22 Amount of penalty for non-payment of cess imposed /
outstanding cess claimed by the assessing officer.
23 Ground for appeal with supporting documents
24 Remarks, if any
Declaration
1. I/We hereby declare that the particulars given above are true to the best of my/our knowledge and
belief and I/We hereby declare that nothing has been concealed or any fact has been mis-represented
in the above calculation made by me/us.
2. I/We hereby declare that I/We am/are quite aware of the penal provisions of the Code on Social
Security, 2020 and if in future anything mentioned in the above self-assessment of cess amount, is
found to be incorrect or inappropriate or any incidence of hiding the facts or under calculation of cess
amount is found, punitive action may be taken against me/us.
Signature and seal of
employer
Name:
Date:
Place:
Mobile Number:
E-mail (if any):
FORM – XX
[See rule 49(3)(a)]
Format for self- assessment of contribution by aggregators of gig workers or platform workers
( to be submitted by 30th June of the current year in which the contribution is payable. )
1 Registration number (LIN) of Aggregator
2 Name of the Aggregator and address/ location of Aggregator
3 Name and address of the authorised person along with contact details
4 Number of gig workers or platform workers engaged with the Aggregator as on opening day of
the current financial year, i.e. 1st day of April in the year in which contribution is payable.
5 Annual turnover of such aggregator of the preceding year
6 Provisional contribution assessment (tick whichever is applicable) -
6.1 % of the annual turnover as notified under sub-section (4) of section 114 for the preceding
year
6.2 5% of amount paid or payable to gig workers and platform workers, by the aggregator during
the preceding year.
7 Amount of contribution payable (in Rs.)
8 Payment of provisional contribution as assessed above.
9 Details of the provisional payment
10 Remarks, if any
Note: For this purpose, the annual turnover of an aggregator shall not include any tax, levy and
cess paid or payable to the Central Government.
Declaration
I/We hereby declare that the particulars given above are true to the best of my/our knowledge and
belief and I/We hereby declare that nothing has been concealed or any fact has been mis-represented
in the above calculation made by me/us.
Signature of authorised person
Along with seal and stamp
Name:
Date:
Place:
Mobile Number:
E-mail (if any):
FORM – XXI
[See rule 49 (3)(b) and (c)]
Format for return to be submitted by Aggregators of gig workers or platform workers
( to be submitted by 31st October, of the current year in which the contribution is payable. )
1 Registration number (LIN) of Aggregator
2 Name of the aggregator and address/ location of aggregator
3 Name and address of the authorised person along with contact details
4 Number of gig workers or platform workers engaged with the aggregator as on
opening day of the current financial year, i.e. 1st day of April in the year in which
contribution is payable.
5 Annual turnover of such aggregator of the preceding year
6 Final contribution assessment after audited statement of account (Amount in
Rs.)
6.1 % of the annual turnover as per notification under sub-section (4) of section
114 for the preceding year
6.2 5% of the liability of the aggregator to gig workers and platform workers
7 Amount of contribution payable (in Rs.)
8 Amount paid as provisional contribution
based on self-assessment.
9 Details of the provisional payment (along with receipt)
10 Amount of outstanding contribution to be paid (Sl. No 7- Sl.No. 8)
11 Proof of payment of outstanding contribution, if any
12 Amount of excess paid contribution, if any
13 In case excess paid, details of the bank account in which excess amount is to be
refunded
14 Remarks, if any
Note: For this purpose, the annual turnover of an aggregator shall not include any tax, levy and
cess paid or payable to the Central Government.
Declaration
I/We hereby declare that the particulars given above are true to the best of my/our knowledge and
belief and I/We hereby declare that nothing has been concealed or any fact has been mis-represented
in the above calculation made by me/us.
Signature of authorised person
Along with seal and stamp
Name:
Date:
Place:
Mobile Number:
E-mail (if any):
FORM – XXII
[(See rule 53 (1)(a))]
REGISTER OF WOMEN EMPLOYEES
1. Name of establishment
2. Name of woman and her father's (or, if married, husband's) name.
3. Date of appointment.
4. Insurance No.(in case covered under ESIC)
5. Provident Fund Registration No.(in case covered under EPFO)
6. Nature of work.
7. Dates with month and year in which she is employed, laid off and not employed.
Month No. of days employed No. of days laid off No. of days not employed Remarks
a b c d e
8. Date on which the woman gives notice under section 62.
9. Date of discharge/dismissal, if any.
10. Date of production of proof of pregnancy under section 62.
11. Date of birth of child.
12. Date of production of proof of delivery/miscarriage/medical termination of pregnancy/
tubectomy operation /death / adoption of child.
13. Date of production of proof of illness referred to in section 65.
14. Date with the amount of maternity benefit paid in advance of expected delivery.
15. Date with the amount of subsequent payment of maternity benefit.
16. Date with the amount of bonus, if paid, under section 64.
17. Date with the amount of wages paid on account of leave under sub-section (1) and (3) of
section 65.
18. Date with the amount of wages paid on account of leave under sub-section (2) of section 65
and period of leave granted.
19. Name of the person nominated by the woman under section 62.
20. If the woman dies, the date of her death, the name of the person to whom maternity
benefits and/or other amount was paid, the amount thereof, and the date of payment.
21. If the woman dies and the child survives, the name of the person to whom the amount of
maternity benefit was paid on behalf of the child and the period for which it was paid.
22. Signature of the employer of the establishment authenticating the entries in the register of
women employees.
23. Remarks column for the use of the Inspector-cum-Facilitator.
FORM XXIII
[(See rule 53(5)]
ANNUAL RETURN
st
FOR THE YEAR …….ENDING 31 December
Single annual integrated return to be filed online under the Occupational Safety, Health and Working
Conditions Code, 2020(37 of 2020), the Code on Industrial Relations, 2020(35 of 2020), the Code on
Social Security, 2020(36 of 2020), and the Code on Wages, 2019(29 of 2019) and the rules made there
under.
Instructions for filling up the Annual Return
(1) This return shall be filled-up and furnished on or before the 28th or 29th day of February every year.
(2) This return consists of two parts i.e. Part-I , which shall be filled up by all establishments.
(3) Part-II shall be filled-up only by the establishments that are Mines in addition to Part-I.
(4)The terms ―establishment‖ and ―mines‖ shall have the same meanings as assigned to them in the
respective Codes.
(5)This return shall be filled-up in the case of contractor or manpower supplier who has engaged
more than 50 workers and in the case of mines, even where one worker was employed during the
relevant period.
Applicable to All Establishments - Part-I
A. General Information:
Sl. Instructions for filling the column
N
o.
1. Labour EPFO, ESIC, MCA, MoLE (LIN)
Identification
Number
2. Period of the From - To- Period should be calendar year
Return
3. Name of the
Establishment
4. Email ID
(employer)
5. Telephone No.
(employer)
6. Mobile number
(employer)
7. Premise name
8. Sub-locality
9. District
10 State
.
11 Pin Code
.
12 Geo Co-ordinates
.
B(a). Hours of Work
in a day
B(b). Number of Shifts
Number of hours
in a shift
C. Details of Manpower Deployed
Directly employed Employed through Contractor Gran
d
Details
Tota
l
Skill HighlySkill Skille Semi- Un- Highl Skille Sem Un-
Category ed d Skille Skille y d i- Skille
d d Skille Skill d
d ed
(i) M/F/T M/F/T M/F/T M/F/T M/F/T M/F/T M/F/TM/F/T
Maxim
um No. of employees employed in the establishment in any
day during the
year
(ii) No. to be M/F/T M/F/T M/F/T M/F/T M/F/T M/F/T M/F/T
Avera indicated
ge No. of employees employed in the establishment during
the year
(iii) Maximum M/F/T M/F/T M/F/T M/F/T M/F/T M/F/T M/F/T M/F/T
number of
Migrant
Worker during
the year
(Section 59 of
OSH&WC
Code)
(iv) Number M/F/T M/F/T M/F/T M/F/T
of fixed term
employee
engaged
D. Details of contractors engaged in the Establishment:
Sl. Name with LIN of the No. of Contract Labour Engaged
No. Contractor
E. Details of various Health and Welfare Amenities provided.
Sl Nature of various welfare Statutory Instructions for filling
. amenities provided (specify the
No statute)
.
1. Whether facility of Canteen Tick yes or no in Applicable to all establishments wherein hundred
provided (as per section24(v) of the box and not or more worker including contract
OSH&WC Code, 2020) applicable labour were
ordinarily employed
2. Crèches(as per section 67of Tick yes or no in Applicable to all establishments where fifty or
Code on Social Security Code, the box and not more workers are employed
2020 and section 24 of the applicable
OSH&WC Code 2020)
2 If 2 above is not given than Tick yes or no in Reference rule.. on Social Security
a whether Crèches allowance the box and not
under Rule.. of Social Security applicable
Code given.
3. Ambulance Room(as per section Tick yes or no in Applicable to mine, building or other construction
24(2)(i) of OSH&WC Code, the box and not work wherein more than five hundred workers are
2020) applicable ordinarily employed
4. Safety Committee (as per section Tick yes or no in Applicable to establishments and factories
22(1) of OSH&WC Code, 2020. the box and not employing 500 workers or more, factory carrying
applicable on hazardous process and BOCW employing
250workers or more,
and mines employing 100 or more workers.
5. Safety Officer (as per section No. of safety In case of mine100 or more workers, in case of
22(2) of OSH&WC Code, 2020) officers
BOCW 250 or more workers and in case of dock
appointed
work 500 or more workers are ordinarily employed.
6. Qualified Medical Practitioner (as No. of There is no specification for minimum number of
per section12 Qualified Qualified Medical Practitioner employed in
(2) of OSH&WC Code 2020. Medical establishment. However, this detail is required to
Practitioner have
appointed. data on occupational health.
F. The Industrial Relations: Instructions for
filling
1. Is the Works Committee has been functioning.(Section 3 of IR Yes/No and Industrial
Code, 2020) not applicable establishment in
which 100 or more
workers are employed
(a) Date of its constitution.
2. Whether the Safety Redressal Committee constituted (Section 4 Yes/No and Industrial
of IR Code, 2020) not applicable establishment
employing 20 or
more workers
3. Number of registered Unions in the establishments.
4. Whether any negotiation union exist(Section14 of IR Code,2020) Yes/No
5. Whether any negotiating council is constituted (Section 14 of IR Yes/No
Code, 2020)
6. Number of workers discharged/dismissed, retrenched or whose services were
terminated during the year:
Dismissed Retrenched Discharged Grand
/Terminated Total
or Removed
7. Man-days lost during the year on account of
Sl. Reasons Period No.
No. /Date of
man-
days
lost
(a) Strike
(b) Lockout
8. Details of retrenchment / lay off
Sl. No. of persons Details of payment No. of No. of man-days Applies on industrial
No. retrenched during paid to retrenched workers laid lost due to lay-off establishment
the period employees off during employing 300 or more
the period workers
G. Details pertaining to maternity benefit:
No. of female
No. of
employees
female No. of female No. of deduction of wages, if
employees availed employees paid any made from female
maternity leave medical bonus employees
H. Details of payment of bonus:
Sl. No. of employees covered Total amount of bonus Date on which the Bonus paid
No. under the Bonus provision actually paid
I. Details of accidents, dangerous occurrence and notifiable diseases:
Sl. Total number of accidents by Total number of fatal Total number of Total number of
No. which a person injured is accidents and names of Dangerous cases of Notifiable
prevented from working for a the deceased as per Occurrences as Diseases specified
period of 48 hours or more as Section 10 of the defined under in Third Schedule of
per section 10 of the OSH&WC Code, 2020. Section 11 of the the OSH&WC Code,
OSH&WC Code, 2020. OSH&WC 2020 along with
Code,2020 the details of affected
persons
J. Man days and production lost due to accidents / dangerous occurrences
Sl. Accident/Dangerous Man days lost Production Lost
No. Occurrence
Part II (For Mines)
A. General information
1. Establishment Name
2. Name of Company/ Name of Owner
3. Type of organization (drop down) PSU Central/ PSU State/ Private/
4. Type of ownership (drop down) Firm/Association/Individual/Partnership/Company
5. Type of Mineral (drop down) Coal/Metal/Oil
6. Name of Mineral
7. Type of Mine (drop down) Belowground/ Opencast/
Aboveground/Mixed/OffShore/OnShore
8. Date of opening To be filled for first time
9 Mine Code To be filled for first time
10. Date of closing (if any) NA/ Calendar to be given
11. Date of reopening (if any) NA/ Calendar to be given
12. Depth of working in mts. Maximum Depth: Minimum Depth:
B. Statutory personnel employed in the mine (as on 31st December)
Sl. No. Designation as per Code Number of Statutory Persons required Number of Statutory
Persons employed
1.
C. Method of Working vis-a-vis Safety Parameters
1 Name of Method (Specify the name) (as per drop
down menu)
2 Quantity of mineral Produced in Cu.m./Tonne
3 Quantity of Waste/overburden removed in
Cu.m./Tonne
4 Stage of Working (as per drop down menu) Development/Extraction/Mixed
5 Permissible Void in Cu.m. For extraction
stage
6 Actual Void in Cu.m. For extraction
stage
7 Area of overhang For extraction
stage
8 Maximum Inflammable gas released in Cu. Meter For
per ton of coal produced Development
stage
9 Overall Pit slope For Opencast
mines
Individual entry for each Pit
10 Overall dump slope For Opencast
mines
Individual entry for each Dump
11 Area of fire in Sq. m.
12 Length of embankment required to be provided
against the water body
13 Length of embankment provided against the water
body
14 Length of fencing required/provided as per statute
15 No. of opening required to be sealed in case of
abandoned mines:
16 No. of Openings sealed in case of abandoned mines:
17 Number of Mock drills conducted and date of same
with coverage of employees
18 No. of Oil/Gas wells: under drilling/ under For Oil and
production/ under work over (as per drop down gas mines
menu)
19 No. of wells where production discontinued For Oil and
gas mines
20 If Yes to pt. 19 above, Action taken
21 Action Taken in respect of Wells where production For Oil and
has been discontinued gas mines
22 Maximum Quantity of explosive used in any day (in For all types
Kgs.) of mine
23 Whether Building or Structures not belonging to Yes/No/NA For Coal &
owner lies within danger zone? Metalliferous
Mines
24 Aggregate HP/KW of machineries For all types
installed/deployed in the mine for the year of mine
D. Medical examinations - Initial/Periodical (IME/PME):
During the year, total number of persons including contractual workers:
Particulars Total No. of Persons
Undergone IME
Undergone PME
Declared medically Temporary unfit
Given alternate Employment due to Medical unfitness
Terminated on account of being medically unfit
E. Details of Vocational training imparted:
During the year, total number of persons including contractual workers:
Particulars Total No. of Persons
Imparted Basic Vocational Training
Imparted Refresher Training
Imparted special Training
F. Details of Accident, Dangerous Occurrence and Occupational Diseases :
(1) Details of Accidents and Dangerous Occurrences:
Sl. Date of No. of persons No. of Number of persons Nature of Mandays
No. Accidents/Dangerous killed persons injured (Excluding Occurrence lost
Occurrences received Serious Bodily
Serious Injury) and thereby
Bodily Injury prevented from
working for a period
of 48 hours or more
1.
(2) Details of Occupational diseases:
Sl. No Notified Disease No. of cases
G. Details of Safety Management Plan:
(a) Safety Management Plan Prepared: (Yes/No/NA)
(b) Date of Submission : Date
(c) Last date of review of Safety Management Plan: Date
(d ) Principal Hazards Identified:
Sl. no. List of Principal Principal hazard Principal hazard not Reasons for failure
hazards identified Mitigation date mitigated till 31st to mitigate the same
December
1.
H. Mines Rescue Station: (For Belowground Mines Only)
A. For Mine: (To be filled by mine owner)
(i) Address of the Rescue Station with Geo-coordinates serving the mines;
(ii) Distance of the Rescue Station from mine opening; -----(in KM)
(iii) Whether a mine Rescue Station has been established by the mine ? (Yes/No)
Mines Rescue Station: (For Belowground Mines Only)
(For Rescue Station)
For Mine Rescue Station (To be filled by the Superintendent of the Rescue Station)
(i) Name of the owner of the mine at which the Mine Rescue Station is located:
(ii) Address of MRS:
(iii) Name of the Superintendent :
(iv) Details of the mine served by the Rescue Station:
Sl. No. Name of the Mines Distance of the Mine from MRS (in Kms)
(v) Details of Personnel Deployed at Rescue Station;
Sl. No. Designation as per Code Number of statutory persons Number of statutory persons
required employed
(vi) Details of Equipment/Apparatus :
Sl. No. Type of Numbers of Equipment/Apparatus available
Equipment/Apparatus
required
(vi) Particulars of Emergency Attended:
Sl.No. Name of the Nature of Response Time Time taken for Rescue & Action Taken
Mine Emergency (time taken by Recovery
rescue services to
attend the
emergency)
(vii) Additional Information :
(a) Number of Rescue Rooms :
(b) Number of Rescue Trained Persons Required :
(c) Number of Rescue Trained Person available :
(d) Whether Canteen facility exist or not? ( Yes/No):
Certified that the tables are duly filled in and the information and figures furnished therein are correct to
the best of my knowledge.
Signature of Employer/Occupier/Owner/Agent/Manager
Place:
Dated:
PART III
ANNUAL RETURN period ending 31st December
(to be submitted by the principal employer on Shram Suvidha Portal)
1. Name of the principal employer:
2. Name of the establishment:
3. Registration number (LIN) of the establishment:
4. Details of the Contractors, wages paid, etc.:
Sl Mont Name LIN of Nam Maximu Amount Date of Amount Date of Remar
. h and the e of m paid payment of the payment ks
address contract the number against of wage wages of
of the or work of wage bill bill paid wages
contracto contract (if directly paid
rs labour applicabl (if to the directly
employe e) to the applicabl contract to the
d contracto e) labour contract
r by labour
(includin Principa by
g EPF, l Principa
ESIC, Employ l
Bonus er (in Employ
etc.) case the er (in
contract case the
or fails contract
to pay) or fails
to pay)
Signature of the principal employer
Date:
PART IV
Shram Shuvidha Portal
Ministry of Labour and Employment
Self-Declaration form for EPFO/ESIC Contribution Year: ___
PAN No:
LIN:(Auto-Populated)
EPF Code No. (Auto-Populated)(Editable): ESI Code No.(Auto-Populated)(Editable): Sub Code
Branch Code Nos. (Auto- Nos. (Auto-Populated)(Editable):
Populated)(Editable):
Statement of salary/wages and contribution in r/o of EPFO
1 2 3 4 5 6 7 8=(5+ 9 10 11 12=( 13
=(2+3) 7) 9-
10)
Mo Total Total Tota Total Total Total Tota Total Total Da Bal No.
nth No. of no. of l no. Wages EPF Wages l Contr contri te anc of
& emplo emplo of paid to Wages paid to wag ibutio bution of e to empl
Ye yees yees empl employ paid to emplo es n paid pay be oyee
ar eligibl not oyee ees employ yees paid Payab me pai s to
e for eligibl s eligible ees not to all le nt d who
memb e for empl for eligibl eligibl empl (Based m
ership memb oyed membe e e oyee on dues
under ership rship under under s column to be
SS under under SS SS 6) paid
Code/ SS SS Code/s Code/s
Sche Code/s Code/s cheme cheme
me cheme cheme
04/20
..
05/20
..
06/20
..
07/20
..
08/20
..
09/20
..
10/20
..
11/20
..
12/20..
01/20..
02/20..
03/20..
• Upload Salary sheet of contribution details of all members as per Form-VIIIB(Register of Wages,
Overtime & Dedcution)
Details of Employees non-enrolled but eligible to be member:
Sr. Name of Gender Aadhaar Father‘s Date Date Date of Wages paid
No Employee Number Name of of Exit(If
Birth Joining already
left)
Contractors details:
S.No. Name & EPF code ESI Nature Maximum Total payment made during the FY
Address No. code of Number of
of the No. work employees
contractor employed
during any
day
<*contractor details may be pre-filled from CLC Licence data if available with option to add other
contractors>
Details of tax benefit claimed by employer by way of contribution towards a recognized provident fund or
an approved superannuation fund u/s 36(1)(iv) of Income Tax Act:
Financial Year Contribution Tax benefit
UPLOAD DCOUMENTS:
S. No. DOCUMENT Name <upload field in portal>
1. Balance Sheet* • <upload field for Balance Sheet of the financial
year>
2. Form 26AS* • <upload field for Form 26AS of the financial year>
3. Form 26Q* • <upload field for Form 26Q of the financial year>
*mandatory field
(Signature of the Employer/authorized representative)
*Section 36(1)(iv) of Income Tax Act:
any sum paid by the assessee as an employer by way of contribution towards a recognised provident fund or an
approved superannuation fund, subject to such limits as may be prescribed for the purpose of recognising the
provident fund or approving the superannuation fund, as the case may be; and subject to such conditions as the
Board may think fit to specify in cases where the contributions are not in the nature of annual contributions of
fixed amounts or annual contributions fixed on some definite basis by reference to the income chargeable
under the head "Salaries" or to the contributions or to the number of members of the fund;
FORM-XXIV
[See rule 54 (1), (2) and (3)]
Notice to the employer for an offence committed under the provisions of the Code for the first
time for compounding of offences under sub-section (1) of section 138
Notice No…………… Date:
On the basis of records and documents produced before me, the undersigned has reasons to believe
that you, being the employer of the establishment…………….. (Registration No………….), have
committed an offence for the violation of provision of the Code or the Schemes or the Rules or the
Regulations framed thereunder as per the details given below:-
PART – I
1. Name of the person:
2. Name and Address of the establishment :
3. Registration No. of the establishment:
4. Particulars of the offence:
5. Provisions of the Code/Scheme/Rules/Regulations
under which the offence is committed:
6. Compounding amount required to be paid towards
composition of the offence:
7. Name and details of account for depositing the
amount specified in serial no. 6:
PART –II
In view of the above, you have an option to pay the entire amount mentioned in serial no. 6 in
Part-I within fifteen days from the date of issue of this notice and return the application duly filled in
Part – III of this notice.
In case the said amount is not paid within the specified time, necessary action for filing of
prosecution shall be initiated without giving any further opportunity in this regard.
(Signature)
(Name and designation of Officer)
Date:
Place:
To:
………………..(Employer/Establishment)
…………………(Name and registration number)
………………….(Address)
PART – III
[See rule 54 (2)]
Application under sub-section (4) of section 138 for compounding of offence
Ref: Notice No………….. Date:
The undersigned has deposited the entire amount as specified in serial 6 of Part-I and the details of
payment are given below with a request to compound the offences mentioned in Part-I.
8. Details of the compounding amount deposited (Copy of electronically generated receipt to be
attached):
9. Details of the prosecution, if filed for the violation of above-mentioned offences may be given:
10. Whether the offence is first offence or the applicant had committed any other offence prior to this
offence, if committed, then, full details of the offence:
11. Any other information which the applicant desires to provide:
Signature of the applicant
(Name and Designation)
Date:
Place:
To:
………………..(Compounding Officer)
…………………(Name of the Office)
………………….(Address)
PART – IV
[See rule 54 (3)]
Composition Certificate
Ref: Notice No………….. Date:
This is to certify that the offence under sub-section ….. of section 133 in respect of which Notice
No. Dated: _____ was issued to Sh…………. (Applicant), the employer of ……………. (name and
registration number of establishment) has been compounded on account of remission of full amount of
Rs ……….. (Rupees _________________) towards the composition of offences to the satisfaction of
the said notice.
(Signature)
Name and Designation of the Officer
Date:
Place:
To:
………………..(Employer/Establishment)
…………………(Name and registration number)
………………….(Address)
FORM-XXV
[See rule 56 (1)(d) and 56 (3)(b)]
Form for reporting vacancies to career centres
(Separate forms to be used for each type of posts)
1 Particulars of the employer:
Name:
Address with pin code:
Telephone No. :
Mobile No.:
Email address :
Name and Type of Establishment
(Central Government, State Government, PSU,
Autonomous, Private, etc)
Registration No of establishment under the Code:
Economic activity details:
2. Particulars of the indenting officer:
Name:
Designation:
Telephone No. :
Mobile No.:
Email address :
3. Particulars of vacancy(ies):
a. Designation/nomenclature of the
vacancy(ies) to be filled
b. Description/Nature of duties of the post
c. Sector
(job role/functional role)
d. Qualifications/Skills required Desirable/Preferable
Essential
(educational, technical, experience)
i. Educational qualifications
ii. Technical qualifications
iii. Skills
iv. Experience
e. Age limits, if any
( Age as on last date of application)
f. Preferences (such as ex-servicemen,
persons with disabilities, women, etc) if
any
g. Number of vacancies
h. duration of employment Number of posts
(i) 3-6 months
(ii) 6-12 months
(iii) 12 months and more
i. Probationary Period, if any and pay and
allowances during that period
j. Provision, if any for pension/Provident
fund:
k. Hours of work, holidays, shifts,
promotional opportunities:
l. Travelling Allowance:
m. Facilities provided by Employer:
i. Housing facilities:
ii. Living conditions at the place of
work:
iii. Educational facilities and medical
facilities at the place of work:
n. Last date to apply:
4 Whether there is any obligation for arrangement for giving reservation/ preference to any
category of persons such as Scheduled Castes (SCs), Scheduled Tribes (STs), Economically
Weaker Sections (EWSs), Other Backward Classes (OBCs), Ex-serviceman and persons
with disabilities (pwd) , etc, in filling up the vacancies: Yes/No
( if yes, give the number of vacancies to be filled by such categories of persons as detailed
below)
Category Number of vacancies to be filled
Total *By Priority candidates
*(Applicable for Central
(a) Scheduled Caste Government vacancies)
(b) Scheduled Tribe
(c)OBC
(d)EWS
(e) Ex-Serviceman
(f) Persons with disabilities (pwd)
(g) women
(h) Others(specify)
5. Pay and Allowances:
For Government vacancies: Mention pay level/pay
scale of the post with basic pay/pay per month
with other details, if any.
For others: Mention minimum total emoluments
per month with other allowances details, if any.
6. Place of work/Job Location ( Name of the
town/village and district, pin code ,etc. in which
it is situated)
7. Mode of application(email, online, in writing, etc)
and last date for receipt of applications.
8. Particulars of Contact person/officer to whom the
applications be sent/candidates should approach
(Mention Name, designation, email id, address ,
Mobile No., website address in case of online)
9. Place of Interview
10 Mode of recruitment
{Through career centre, placement agency , self-
management, any other mode(specify) }
11 Would like to obtain list of eligible candidates Yes/No
registered with Career Centre
12 Any other relevant information
Signature, Name and Designation of authorised signatory of establishment/ employer with seal
and date
(For Official Use- to be filled by Career Centre)
13 Name, address, email id of the Career Centre
14 Date of receipt of Vacancies
15 NIC Code of the establishment/
16 NCO Code of the post
17 Unique Vacancy ID(number)
18 Order No./ Diary No.
Signature
Name& Designation of Authorised Signatory
of Career Centre with seal & date
NOTE:
1. Career Centre to which the vacancies are reported, would provide a unique vacancy reporting
number for the vacancy reported andconvey it to the employer in writing, through email or
digitally or through any other such media immediately but in any case not later than seven
working days from the date of receipt of reporting of vacancies in north-eastern States and
three working days in other States.
2. An employer, if advertises that vacancy in any media or makes recruitment through any
agency or any other mode, may invariably quote that unique vacancy reporting number in that
advertisement or recruitment process.
3. Any change in the particulars already furnished to the Career Centre, shall bereported in
writing or through valid official email or digitally (including through a portal) as the case may
be, to the appropriate Career Centre.
FORM-XXVI
[See rule 56(1)(d) and 56 (6)]
Form EIR (Employment Information Return)
YearlyReturn to be submitted to the Career Centre (Regional) for the Yearended…………….
The following information is required to be submitted under the Code on Social Security,
2020 (Chapter XIII – Employment Information and Monitoring).
Name and address of the employerwith Pin code
Email ID of the Employer
Mobile No. / Contact No. of the Employer
Name of Establishment
Type of Entity
(Factory, shop, commercial office, mine, plantation, etc.)
Type of Ownership
(Firm/Association/Individual/Partnership/Company, etc.)
Whether – Head Office
If yes, specify
Branch Office
If yes, specify
(a)
(b)
(c)
Type of Establishment {Public Sector (Central) / Public Sector (State) / Private Sector}
Nature of business/principal activity
Labour Identification Number – (LIN Number)
Establishment Registration No. under the Code
1. (a) EMPLOYMENT
Total number of manpower of establishment including working proprietors/partners/contingent paid
and contractual workers, out-sourced workers excluding part-time workers and apprentices. (The
figures should include every person whose wage or salary is paid).
Category On the last working day of the On the last working day of the
previous Year Year under report
Highly Skilled Semi- Highly Skilled Semi-
Skilled Skilled Skilled
Skilled
Men
Women
Other (Transgender)
TOTAL :
PWD(persons with disabilities)
out of above total
2. Number of vacancies* occurred and reported to career centre during the year and the
number of vacancies filled during the year
Occurred Reported Filled Source (career centre/ NCS Portal/ Govt. Recruiting Agencies/
Private Placement Organisations/ others)
career career
centre centre
(Regional) (Central)
1 2 3 4 5
*As per the provisions of the Code on Social Security, 2020 (Chapter XIII) and rules made
thereunder.
3. MANPOWER SHORTAGES:
Vacancies/posts remained unfilled because of shortage of suitable applicants.
Name of the occupation or designation Number of unfilled vacancies/posts
of the post
Skill/ qualifications (educational / Essential Desirable
technical/ experience)
prescribed
1 2 3 4
(Please list any other occupations also for which this establishment had any difficulty in obtaining
suitable applicants recently.)
4. Estimated Manpower Requirement by Occupational Classification during the next financial
year (Please give below the number of employees in each occupation separately).
Occupation Number of employees
Please give as far as possible approximate number of vacancies in each occupation you
are likely to fill during the next financial year due to retirement/ expansion or re-
organisation.
Description Men Women Others Total PWD
(trans-gender)
(persons with disabilities) out of total
1 2 3 4 5 6
*
Total :
* In the column(description) -Use exact terms such as Engineer (Mechanical),Assistant
Director(Metallurgist);Research Officer (Economist);Supervisor (Tailoring),Inspector(Sanitary),
Superintendent (Office) , Manager(Sales), Manager(Accounts), Executive(Marketing), Data Entry
Operator............................so on.
Signature, Name and Designation of Authorised Signatory
of establishment/ employer with seal and date
To
The Career Centre,
……………………………..
Note:- 1. This return is to be rendered to the Career Centre (Regional) within 30 days after the end of
the financial yearconcerned by establishments/employers vide their obligation under the Code on
Social Security, 2020( Chapter XIII-Employment Information and Monitoring).
2. The main purpose in obtaining the information from employers is to know (i) the
vacancies/employment opportunities available; (ii) type of personnel who are in short supply; and (iii)
future job opportunities for providing vocational guidance to the jobseekers and connecting them with
the employers. This is helpful in ascertaining the skill needs also. Employers too will be able to call
on the Career Centres for getting suitable candidates as per their requirements.
Form-XXVI(A)
[See Rule 56 (1)(d)]
Form for reporting of Job seeker Information
Sr. Particulars Description
No.
1. Name:
2. Father‘s Name:
3. Mother‘s Name:
4. Date of Birth:
5. Place of Birth:
6. Aadhaar No. of Jobseeker:
7. Mobile:
8. Gender: i. Male
ii. Female iii. TG
(Transgender)
9. Location: i. Rural
ii. Urban
10. Marital Status: i. Married
ii. Unmarried
iii. Divorced
iv. Widow
v. Widower
11. Category: i. General
ii. SC
iii. ST
iv. O.B.C.
12. Religion: i. Hindu
ii. Muslim
iii. Christian
iv. Sikh
v. Others
13. Reservation Category: i. PwD (Differently abled)
ii. Ex-Serviceman
iii. EWS
14. i. If Disability type: (OH/VH/HH/PwBD other)
differe
ntly
abled:
ii. Disability percentage:
a. Below 40%
b. 40-60 %
c. 60-80%
d. Above 80%
15. # Employment Status: i. Employed
ii. Unemployed
iii. Self- Employed
iv. Student
16. Language Known:
(Primary Language) Language Read Speak Write
1.
2.
3.
17. Physical Fitness:
i. Height (in cms.):
ii. Chest (in cms.):
iii. Weight (in kgs.):
iv. Eye Sight:
v. Partial Disability:
क. Blind:
ख. Deaf:
ग. Dumb:
18. Address with pin code:
19. Qualification:
(Starting from Highest Education)
Passed Exam Subject Boards/Uni./ Year Class Div. Certificate No.
Code Grade
School Name
Other Training/ Key Skills:
20. Medium of Education:
21. Specialization / Major:
22. Additional Course/Certificate
i. Name:
ii. Year:
iii. Issued by:
23. Professional Desired Employment:
24. Vocational Guidance: Yes/No
If Yes, Trade
Code:
25. # Work Experience
Sector Organisation Designati Specialization Period Experience
on Certificate
Code Type
From To Yes No
Central/State/
Central
PSU/State
PSU/Local
Bodies/
Autonomus/
Company/
NGO/
Partenship/
Proprietorship/
Others
26. Available to Join (in days):
27. To be filled by Ex-Serviceman:
i. Number:
ii. Joining Date:
iii. Release Date:
28. Reasons for leaving Job:
Self Employment (To be filled by the candidate interested in Self employment)
1 Are you currently self employed Yes/No
If Yes, Specify details:
2 (i) Loan availed previously for Self Employment: Yes/No
If yes,
क. Bank Name
ख. Branch (ii)
Defaulter:
If yes,
क. reason for late payment
ख. Balance amount
Yes/No
3 Are you interested in Self Employment: Yes/No
If yes,
Desired self Employment:
4 Are you or your family member defaulter of any Yes/No
finance institute or bank:
If yes,
i. Bank Name:
ii. Branch: iii.
Outstanding Balance:
All the above information is based on my inputs and is true to the best of my knowledge.
Note: # Furnishing of information to item no. (15&25) will not affect your prospects of
obtaining employment through employment exchanges.
## To be filled by those interested in seeking placement services in the Police Department,
Paramilitary Forces/Armed Forces etc.
FORM-XXVII
[See rule 59(1)]
Application for Compensation
To
The Competent authority for Employee‘s Compensation.
Applicant residing at
Versus
OppositeParty residing at
It is hereby submitted that:-
(1) The applicant, an employee employed by (a contractor with) the opposite party on the ___ day of
___ 20__ received personal injury by accident arising out of and in the course of his employment.
The cause of the injury was (here insert briefly in ordinary language the cause of the injury)
(2)The applicant sustained the following injuries namely:--
(3) The monthly wages of the applicant amounttoRs. . The applicant is over/under the age of 15
years.
(4 ) (a) Notice of the accident was served on the ___dayof____
(b) Notice was served as soon aspracticable.
(c)Notice of the accident was not served (in due time) by reasonof.
(5) The applicant is accordingly entitled to receive:--
(a) half monthly payment of Rs. from the 20 to ___
(b) a lump sum payment ofRs.
(6)The applicant has taken the following steps to secure a settlement by agreement, namely,-
_ _ _ butithasprovedimpossibletosettlethequestionindisputebecause .
*You are therefore requested to determine the following questions in dispute, namely: --
(a)Whether the applicant is an employee within the meaning of theCode;
(b)Whether the accident arose out of or in the course of the applicant‘s employment;
(c)Whether the amount of compensation claimed is due, or any part of that amount;
(d)Whether the opposite party is liable to pay such compensation as isdue;
(e)etc., (asrequired)
Date 20.
Applicant
* Strike out the clauses which are not applicable.
FORM-XXVIII
[See rule 59(2)]
Certificate by the applicant
To
The Competent authority for Employee‘s Compensation
It is hereby submitted that: -
I/We hereby declare that the particulars given in Form XXVII are true to the best of
my/our knowledge and belief and I/We hereby declare that nothing has been concealed or no fact has
been mis-represented in the above said form made by me/us.
Dated:
Applicant.
FORM-XXIX
[See rule 58(1)]
Whereas a claim for compensation has been made by .................. (applicant) against.................and the
said applicant has claimed that he is entitled to file an application under clause (b) or (c) of sub-
section (1) of section 92 of the Chapter VII under the Code on Social Security, 2020;
And whereas the undersigned is satisfied that the said applicant is entitled to file the aforesaid claim;
Now, therefore, the competent authority for Employees Compensation.........................../Government
of........................ is hereby given notice that the undersigned proposes to settle the claim of the
applicant as provided under the Code.
Dated: Competent authority
FORM-XXX
[See rule 62(1)]
To
.................................................................
Sir,
The report about an accident which occurred on.................................at..........................(here enter
details of premises) and which resulted in death/disablement of the employee is furnished as given
below :—
1. (a) Name of the employee ----------- Sex --------- Age ------------
(b) Monthly wages
(c) Nature of employment
(d) Name of the employer
(e) Full postal address of the employee/dependants (local and permanent both).
(f) Full postal address of the factory/establishment where its registered office is located.
2. The circumstances leading to death/disablement of the employee :—
(a) Time of the accident
(b) Place where the accident occurred
(c) Manner in which deceased was/were employed at that time
(d) Cause of the accident
3. The amount of money deposited by the employer with the competent authority under section 81.
4. (a) Details of compensation paid, if any
(b) Particulars of money invested for the benefit of dependants of deceased employee.
5. Documents forwarded (in original) as under :—
(a) Death certificate
(b) Disablement certificate from the competent medical authority
(c) Receipt for Deposit of Compensation by the employer
(d) Statement of Disbursement
(e) Receipt of compensation from the employee/dependants
(f) Memorandum of Agreement, if any
[F. No. R-11011/03/2020-SS-II]
ASHUTOSH A.T. PEDNEKAR, Jt. Secy.
Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064
SARVESH KUMAR
Digitally signed by SARVESH
KUMAR SRIVASTAVA
SRIVASTAVA Date: 2026.05.08 22:05:34 +05'30'
and Published by the Controller of Publications, Delhi-110054.Application and evidence
- Primary statutory test — On the recommendations of the authority or the competent authority or Social Security Organisation, if the Central Government is satisfied that any establishment or any person has misused any benefit provided under the Code or these rules, the Central Government may by notification, deprive such establishments or such person, as the case may be, from such benefit for such time as may be specified in the notification:
- Additional operative limb — Provided that no such order shall be passed unless an opportunity of being heard is given to such establishment or such person, as the case may be. ***** FORM- I [See rule 13 (2)(a)] APPEAL UNDER SECTION 23 OF THE CODE ON SOCIAL SECURITY, 2020 Title of the case:
- Qualification / exception to test — Provided that no such order shall be passed unless an opportunity of being heard is given to such establishment or such person, as the case may be. ***** FORM- I [See rule 13
- Numerical or timing control — Signature of the Employee FORM-IV [(See rule 33(1)] Application for gratuity by an Employee/nominee/legal heir (Strike out the words not applicable) To,…………………………………………………………………………… (Give here name or description of the establishment with full address) Sir/Madam, I, ………………………..(name of employee/nominee/legal heir) /nominee of late…………………………….(Name of the…
- Code Section mapping — 148. Read the mapped provision together with this text rather than treating the concordance as a substitute for it.
- Evidence file — retain facts and records proving the role/status of: Employer, Employee / worker, Worker, Appropriate Government, Central Government, State Government.
Cross-references & prescribed forms
Sections cited/mapped
Forms
No form is directly mapped in the current rule register.
Worked example
For a worker/member seeking a benefit connected with manner of determining misuse of any benefit by an establishment or by any other person under section 148, the file should show coverage, service/contribution facts, the rule/scheme and prescribed form, and the calculation/payment. One statutory point to test is: “Signature of the Employee FORM-IV [(See rule 33(1)] Application for gratuity by an Employee/nominee/legal heir (Strike out the words not applicable) To,…………………………………………………………………………… (Give here name or description of the establishment with full address) Sir/Madam, I, ………………………..(n” Also test the express qualification/proviso before concluding the result. Reconcile the mapped Code Section(s) 148.
Illustrative only. Use the exact notified rule, prescribed form and competent authority.
Q&A — Rule 69
What is Rule 69 of the Social Security (Central) Rules, 2026?
Rule 69 — Governs manner of determining misuse of any benefit by an establishment or by any other person under section 148 and the rights, duties, powers or procedure expressly stated in this rule. Key operative text: On the recommendations of the authority or the competent authority or Social Security Organisation, if the Central Government is satisfied that any establishment or any person has misused any benefit provided under the Code or…
What does Rule 69 require or permit?
A principal operative clause extracted from the notified rule is: “On the recommendations of the authority or the competent authority or Social Security Organisation, if the Central Government is satisfied that any establishment or any person has misused any benefit provided under the Code or these rules, the Central Government may by notification, deprive such establishments or such person, as the case may be, from such benefit for such time as may be specified in the notification:” Read it with all sub-rules and provisos below.
Does Rule 69 contain a proviso or explanation?
Yes. One extracted qualification is: “Provided that no such order shall be passed unless an opportunity of being heard is given to such establishment or such person, as the case may be. ***** FORM- I [See rule 13”
What deadline, period, percentage or amount appears in Rule 69?
The rule contains this numerical/time expression: “Signature of the Employee FORM-IV [(See rule 33(1)] Application for gratuity by an Employee/nominee/legal heir (Strike out the words not applicable) To,…………………………………………………………………………… (Give here name or description of the establishment with full address) Sir/Madam, I, ………………………..(name of employee/nominee/legal heir) /nominee of late…………………………….(Name of the…” Apply it only in its notified context.
Which Code sections are linked to Rule 69?
The current concordance maps Rule 69 to Section(s) 148.
When did Rule 69 come into force?
The final Central Rules were notified as G.S.R. 344(E), 8 May 2026; Rule 1 states that the Rules come into force on publication. Check any later amendment or corrigendum before reliance.
Primary sources
Social Security (Central) Rules, 2026 — official Gazette PDF ↗
Code on Social Security, 2020 — India Code ↗
Source check: 20 August 2026.
Jurisdiction note: This is the Central Rule corpus. Check State rules/notifications where the State Government is the appropriate Government and check later Gazette amendments before acting.