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Sr. No.

Form Name

Name and Applicable rule number

Objective of form / By whom filled up / Procedure for form fill up

Form A

Application for Objective

of

form

:-

DEPOSIT

OF

Registration of COMPENSATION FOR FATAL ACCIDENT / Trade Unions Rule 6 (1) 2 Form B Register Trade Unions Rule 6 (1) 3 Form C Certificate of Objective of form / By whom filled up / of Objective of form / By whom filled up / By whom filled up / Procedure for form fill up

Procedure for form fill up

Registration of Procedure for form fill up Trade Union 4 Form D Annual Return Objective of form section 28 / By whom filled up up / Procedure for form fill

Sr. No.

Form Name

Applicable rule number

Objective of form / By whom filled up / Procedure for form fill up

Form A

Rule 6 (1)

Objective

of

form

:-

DEPOSIT

OF

COMPENSATION FOR FATAL ACCIDENT By whom filled up :- Employer Procedure for form fill up:An employer depositing compensation with the Commissioner under sub-section (1) of section 8, in respect of a workman whose injury has resulted in death shall furnish therewith a statement in Form A.

Form AA

Rule 6 (1)

Objective of form :- DEPOSIT OF COMPENSATION FOR


NON-FATAL ACCIDENT TO A WOMAN OR PERSON UNDER LEGAL DISABILITY

By whom filled up :- Employer Procedure for form fill up;In case of other than death, deposit with the Commissioner under sub-section (1) of section 8, the employer shall furnish a statement in Form AA

Form B

Rule 6

Objective of form :- RECEIPT FOR COMPENSATION By whom filled up :- Commissioner Procedure for form fill up:-

Form C

Rule 6

Objective of form :- STATEMENT OF DISBURSEMENTS By whom filled up :- Commissioner

Procedure for form fill up 5 Form D Rule 9 Objective of form :- DEPOSIT OF COMPENSATION FOR
NON-FATAL ACCIDENTS, OTHER THAN TO A WORKMAN OR PERSON UNDER LEGAL DISABILITY

By whom filled up:- Employer Procedure for form fill up:An employer depositing compensation in accordance with sub-section (2) of section 8, shall furnish therewith a statement in Form D.

Form E

Rule 9

Objective of form:- RECEIPT FOR COMPENSATION By whom filled up:- Commissioner Procedure for form fill up:-

Form EE

Rule 11

Objective of form:- REPORT OF FATAL ACCIDENTS By whom filled up:- Employer Procedure for form fill up:Section 10B of the Act

requires a report of fatal accident and serious bodily injuries to be given to the Commissioner. This report is required to be in the format prescribed in Form EE.

Form F

Rule 20

Objective of form :- APPLICATION FOR COMPENSATION


BY WORKMEN

By whom filled up:- Applicant Procedure for form fill up:- Where an accident occurs
in respect of which liability to take compensation under this Act arises, a claim for such compensation is to be made before the Commissioner in duplicate in Form F which shall be signed by the applicant. There shall be appended to every such application a certificate, witch shall be signed by the applicant, to the effect that the statement of facts contained in the application is to the best of his knowledge and belief accurate.

Form G

Rule 20

Objective of form:- APPLICATION FOR ORDER TO


DEPOSIT COMPENSATION

By whom filled up :- Applicant Procedure for form fill up:commissioner by registered May be sent to the or personally, in post

duplicate under the signature of the applicant along with a certificate by the applicant ie the fact are accurate to best of his knowledge.

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Form H

Rule 20

Objective of form:- APPLICATION FOR


COMMUNICATION

By whom filled up:- Applicant Procedure for form fill up:11 Form J Rule 39(1) Objective of form:- NOTICE By whom filled up :- Commissioner Procedure for form fill up:12 Form JJ Rule 39(3) Objective of form:- NOTICE By whom filled up:- Commissioner Procedure for form fill up:13 Form K Rule 48 Objective of form:- MEMORANDUM OF AGREEMENT By whom filled up :- Workman Procedure for form fill up:14 Form L Rule 48 Objective of form:- MEMORANDUM OF AGREEMENT By whom filled up:- Workman

Procedure for form fill up:15 Form M Rule 48 Objective of form :- MEMORANDUM OF AGREEMENT By whom filled up:- Workman Procedure for form fill up:16 Form N Rule 49 Objective of form:Agreement Notice to record a Memorandum of

By whom filled up :- Commissioner Procedure for form fill up:17 Form O Rule 49 & Objective of form :50(2)
Agreement Ination of Decision on Recording of

By whom filled up :- Commissioner Procedure for form fill up:18 Form P Rule 50(2) Objective of form:Agreement Refusal to Register Memorandum of

By whom filled up :- Commissioner Procedure for form fill up:19 Form Q Rule 50(2) Objective of form:Show Cause Notice on Refusal to

Register Memorandum of Agreement

By whom filled up:- Commissioner Procedure for form fill up:20 Form R Rule 52 Objective of form:- Register of Agreements to be maintained
by the Commissioner

By whom filled up:- Employer Procedure for form fill up:-