Goa Social Security Rules (Draft): full text and citation

Panaji, 02nd May, 2026 (Vaisakha 12, 1948)

SUPPLEMENT

No. 2 Date : 30-Apr-2026 The following draft Rules, namely the Goa Social Security Rules, 2026, which the Government of Goa proposes to make in exercise of the powers conferred by Sections 154 and 156 of the Code on Social Security, 2020 (Central Act No. 36 of 2020) (hereinafter referred to as the “said code”) and in supersession of the earlier Draft Rules published in this regards vide Notification No. 24/20/2021/Lab./564 dated 16-11-2021 published in the Official Gazette, Series I No. 35 dated 25th November, 2021 are hereby pre-published as required by Section 158 of the said Code, for information of the persons likely to be affected thereby and notice is hereby given that the said draft rules will be taken into consideration by the Government after the expiry of a period of forty-five days from the date of publication of this Notification in the Official Gazette. All objections and/or suggestions to the said draft Rules may be forwarded to the Secretary (Labour), Secretariat, Porvorim before the expiry of said period of forty-five days so that they may be taken into consideration at the time of finalization of the said draft Rules.

DRAFT RULES

CHAPTER I

Suggestions are welcomed on e-mail: dir-gpps.goa@nic.in

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(a) “agency” means any corporation, body or institution, established under an Act of Parliament or State Legislature as notified by the Government;
(b) “appeal” means an appeal preferred under any applicable section of the Code on Social Security, 2020 (36 of 2020);
(d) “Assessing Officer” means a Gazetted officer of the State Government appointed by Government for assessment of cess under Chapter VIII of the Code;
(e) “Authorised Officer” means a officer designated by the Government either generally or in respect of any area or class of areas, for the purposes of performing the functions assigned by these rules to the authorised officer;
(g) “Average daily wages during a wage period” means— Provided that where an employee receives wages without working on any day during such wage period, he shall be deemed to have worked for 26, 13, 6 or 1 days or day if the wage period be a month, a fortnight, a week or a day respectively. Explanation.— Where any night shift continues beyond midnight, the period of the night shift after midnight shall be counted for reckoning the days worked as part of the day preceding;
(h) “benefit period” means the period not exceeding six consecutive months corresponding to the contribution period, as may be specified in the Regulations;
(i) “Board” means the Goa Unorganised Workers Social Security Board and the Goa Building and Other Construction Workers Welfare Board constituted under sub-section (9) of Section 6 and under sub-section (1) of Section 7 of the Code, respectively;
(j) “career center” means the career centre as notified by the State Government or the Regional Employment Exchange of the State Government;
(k) “cess collector” means an officer appointed by the Government for collection of cess under the code;
(l) “Chairperson” means the Chairperson of the Board;
(m) “chartered engineer” means a person having an engineering degree and the corporate membership of Institute of Engineers of India;
(о) “Contribution period” means the period not exceeding six consecutive months, as may be specified in the Regulation;
(p) “Court” means Employees State Insurance Court constituted under Section 48.

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(q) “electronically” means any information maintained, submitted by email or uploading on the designated portal or digital payment in any mode for the purpose of Code;
(r) “excluded vacancies” means those vacancies which have been excluded from the purview of Section 139 as per the provisions of sub-section (I) and (2) of Section 140;
(s) “Form” means a form appended to these rules;
(t) “fund” means the Employees State Insurance Fund, the Employees’ Provident Fund, Employees’ Pension Fund, the employees’ Deposit-Linked Insurance Fund or the Social Security Fund, as the case may be;
(u) “Government” means the Government of Goa;
(ν) “Government Securities” means Government Securities as defined in the Government Securities Act, 2006 (Central Act 38 of 2016);
(w) “immovable property” includes land, benefits to arise out of land, things attached to the earth, or permanently fastened to anything attached to the earth;
(x) “movable property” means property of every description except immovable property;
(y) “member” means a member of the Board;
(z) “nodal officer” means a person designated by Building and Other Construction Worker’s Welfare Board or the State Government to facilitate the registration, renewal and updation electronically or otherwise or for any such other function of building workers working in the private sector, State Government, Central Government and public sector undertakings of the Central and State Government or local authority including supervising and monitoring the functions of the beneficiary registering officers designated by the State Government.
(aa) “nominations” means nomination made under Section 55 of the Code;
(ab) “Registered Medical Practitioner” means a medical practitioner whose name has been enrolled in a register maintained under any law for the time being in force regulating the registration of practitioners of medicine;
(ae) “specified” means specified by the Government by an order published in the Official Gazette.
(ah) “year” means the financial year, beginning from the 1st day of April and ending with the 31st day of March of the year following.
(2) All other words and expressions used in these rules which are not defined herein, but are defined in the Code shall have the same meaning as are respectively assigned to them under the Code.

CHAPTER II

Social SecurityOrganisations

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membership of the Board under rule 7, he shall hold office only for the remainder of the term of office of the member in whose place he is so nominated: Provided that a member nominated under sub-clause (iii) of Clause (d) of sub-section (10) of Section 6 shall cease to be a member of the Board if he ceases to be a member of the Legislative Assembly of Goa:

4. Resignation.—(I) A member of the Board, not being an ex-officio member, may resign his office by a letter in writing addressed to the Chairperson.
1. Removal of member.— The Government may remove from office, any member of the Board, if, in its opinion, such a member has ceased to represent the interest which he purports to represent on the Board:
(2) If a member changes his address, he shall furnish his new address to the Member-Secretary of the Board who shall thereupon enter his new address in the official record: Provided that if a member fails to furnish his new address, the address in the official record shall for all purposes be deemed to be the member's correct address. Provided that when a vacancy occurs or is likely to occur due to removal or resignation of a member, the Member-Secretary shall submit a report to the Government and on receipt of such report, the Government may, by notification in the Official Gazette nominate a person to fill the vacancy and the person so nominated shall hold office for the remaining term of office of the member in whose place he is nominated.
1. Allowances of members.— (I) The travelling allowance of an official member of the Board shall be governed by the rules applicable to him for journey performed by him on official duties and shall be paid by the authority paying his salary.
(2) The non-official members of the Board shall be entitled to the payment of travelling and daily allowance for attending the meetings of the Board at such rates as are admissible to Group ‘A’ Officers of the Government.
1. Disposal of business.— Every matter which the Board is required to take into consideration shall be considered at a meeting of the Board, or if the Chairperson so directs, by sending the necessary papers to

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every member for opinion, and the matter shall be disposed of in accordance with that decision of the majority: Explanation.— The expression “Chairperson” for the purpose of the above proviso shall include a member nominated or chosen under sub-rule (2) of rule 10 to preside over a meeting.

10. Meetings.— (1) The Board shall meet at such places and at such times as may be decided by the Chairperson and it shall meet at least once in a quarter of the year.
(2) The Chairperson shall preside over every meeting of the Board in which he is present and in his absence, he may nominate a member of the Board to preside over such meeting in his place and in the absence of such nomination by the Chairperson, the members of the Board present in such meeting, may choose one member from amongst themselves to preside over the meeting.
1. Notice of meetings and list of business.— (I) Ordinarily, atleast twenty one days notice shall be given to the members of the Board of a proposed meeting alongwith the copy of the agenda.
(2) No business except which is included in the list of business for a meeting of the Board shall be considered at the meeting without the permission of the Chairperson.
(3) The Chairperson may at any time call a special meeting of the Board in case of urgency, after informing the members in advance about the subject matter of discussion and the reasons of urgency.
1. Quorum.— (I) No business shall be transacted at any meeting of the Board unless at least ten members are present in that meeting which shall include at least one non-official member. Provided that if at a meeting, less than ten members are present, the Chairperson may adjourn the meeting to another date informing the members present and giving notice to the other members that he proposes to dispose of the business at the adjourned meeting whether there is prescribed quorum or not, and it shall there upon be lawful for him to dispose of the business at the adjourned meeting irrespective of the number of members attending.
(2) A member, other than ex-officio member, shall cease to be a member of the Board if he remains absent for three consecutive meetings of the Board without the leave of absence from the Chairperson.
1. Proceedings of the meeting.— (I) The proceedings of each meeting showing inter alia the names of the members present thereat shall be forwarded to each member of the Board, as soon as possible after the meeting, and in any case not less than seven days before the next meeting.
(2) The minutes of each meeting shall be confirmed with such modifications as may be considered necessary at the next meeting.
1. Terms and conditions of appointment of the Chairperson and other members of the Board.— (I)

The term of office of Chairperson and other members of the Board other than the Official members shall be three years from the date of their appointment: Provided that the members may continue in office till their successors are appointed:

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Appointment of Secretary and other officers and employees.— The Board shall appoint a secretary and such other officers and employees as it considers necessary for the efficient discharge of its functions and shall be paid such salary and allowances, as may be determined by the Board from time to time with the approval of the Government. Provided that the members may continue in office till their successors are appointed:
Filling up of casual vacancies.—A member nominated to fill a casual vacancy shall hold office for the remaining period of the term of office of the member in whose place he is nominated.
Meeting of the Board.— The Board shall ordinarily meet once in three months. Provided that the Chairperson shall, within fifteen days of the receipts of a requisition in writing from not less than one-third of the members of the Board, call a meeting thereof.
Notice of meeting and list of business.— Notice intimating the date, time and venue of every meeting together with a list of business to be transacted at the meeting shall be sent by registered post or by special messenger, to each member fifteen days before the meeting: Provided that when the Chairperson calls a meeting for considering any matter, which in his opinion is urgent, notice of not less than three days shall be deemed sufficient.
Chairperson to preside at meetings.—(I) The Chairperson shall preside over every meeting of the Board in which he is present and if for any reason the Chairperson is unable to attend the meeting any member nominated by the Chairperson in this behalf shall preside over the meeting. (2) When the Chairperson is absent and no member has been nominated by the Chairperson under sub-rule (I), the members present shall elect one of them to preside over the meeting and the member so elected shall exercise all the powers of the Chairperson in conducting the meeting. (3) No business shall be transacted at any meeting of the Board unless, atleat six members are present of whom one shall be non-official member.
Absence from the State.— If any member leaves the State for a period of not less than six months without intimation to the Chairperson, he shall be deemed to have resigned from the Board.
Minutes of the meeting.— Every decision taken at a meeting of the Board shall be recorded in a minutes book at the same meeting and signed by the Chairperson. The Minutes Book shall be a permanent record.

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(2) Sub-committee shall consist of the following persons, namely:—
(c) One member representing the building workers;
(3) The Chairperson of the Board shall be the Chairperson of the sub-committee also. If the Chairperson is absent at any time the members present shall elect one among them to preside over the meeting.
(5) The term of the sub-committee shall be one year from the date of its constitution: Provided that the sub-committee shall continue in office after expiry of one year until a new sub-committee is constituted: Provided further that in no case, the sub-committee shall continue beyond a period of two years from the date of its original constitution.
(6) The recommendations of the sub-committee shall be placed before the Board for its decision.
1. Powers, duties and functions of the Board.—(1) The Board shall be responsible for,
(a) all matters connected with the administration of the Fund;
(b) laying down policies for the deposits of the amount of the Fund;
(c) submission of annual budget to Government for sanction;
(d) submission of annual report to Government on the activities of the Board;
(e) proper maintenance of accounts;
(f) annual audit of accounts of the Board, in accordance with provisions of the Act;
(g) collection of contribution to the Fund and other charges;
(h) launching of prosecutions for and on behalf of the Board;
(i) speedy settlement of claims and sanction of advances and other benefits;
(j) proper and timely recovery of any amount due to the Board.
(2) The Board shall furnish information to Government on such matters as the Government may refer to it, from time to time.
1. Secretary of Board.— (I) The Secretary of the Board shall be the Chief Executive Officer of the Board,
1. Appointment of Secretary and other officer.— The Board shall appoint a secretary and such other officers and employees as it considers necessary for the efficient discharge of its functions under the Act.
1. Administrative and financial powers of the Secretary:— (I) The Secretary of the Board may, without reference to the Board, sanction expenditure and contingencies, supplies and services, purchase of

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articles, refund, subject to the limits up to which he may be authorised to sanction expenditure, on any single item, from time to time, by the Board.

(2) The Secretary may also exercise such other administrative and financial powers other than those specified in sub-rule (I), above as may be delegated to him from time to time by the Board.
(3) The Board may, from time to time, delegate, subject to such conditions as it may deem fit, administrative and financial powers to any other officer under its control and supervision to the extent considered necessary for its efficient functioning.
1. Other Welfare Schemes.— The Board may formulate or make applicable following scheme(s) for the Building workers
(i) Group Insurance Scheme for Building workers;
(ii) Educational schemes for the benefit of children of Building workers; and
(iii) Treatment of major ailments of Building workers and their dependant.

CHAPTER III

Employes Insurance Court

1. Procedures to be followed by the Employees State Insurance Court.— (I) Every proceeding under Section 49 shall be instituted by filing of an application to the Court.
(2) Every such application shall be verified in the same manner as a pleading in a Civil Court and shall be accompanied by two copies thereof.
(3) An application under sub-rule (I) shall be in Form I hereto shall be duly stamped and shall contain the following particulars:
(i) the name of the Court in which the application is brought;
(ii) the full name including the father's name, description, including age, occupation and place of residence of the applicant; the full name including the father's name, description, including age, occupation and place of residence of the opposite party so far as they can be ascertained;
(iii) where the applicant or the opposite party is a minor or a person of unsound mind a statement to that effect and the full name, age, occupation and address of his or her next friend or guardian;
(iv) the facts constituting the cause of action and the date when it arose;
(v) the facts showing that the Court has jurisdiction;
(vi) particulars giving the address within the jurisdiction of the Court at which notice or summons may be served on the applicant; and
(vii) the relief which the applicant claim.
1. The Court may summarily reject an application if it is not in accordance with sub-rule (3).
(2) Any other document which any party desires to submit in evidence shall be produced at or before the first hearing.
(3) Any document which is not produced as specified in sub-rule (I) or (2), shall not, without the permission of the Court, be admissible in evidence on behalf of the party who should have produced it.
(4) All such documents shall be accompanied by an accurate list thereof prepared in Form-II hereto.
(5) Nothing in this rule shall apply to any document which is produced for the purpose of cross-examining a witness or is handed to a witness to refresh his memory.

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(i) the opposite party or each of the opposite parties, where there are more than one, at the time of commencement of the proceedings, actually and voluntarily reside, or carries on business, or personally works for gain; or
(ii) any of the opposite parties, where there are more than one, at the time of the commencement of the proceedings actually and voluntarily resides, or carries on business, personally works for gain, provided that in such case either the leave of the Court is given, or the opposite parties who do not reside, or carry on business or personally work for gain, as aforesaid, acquiesce in such institution; or

Application presented to wrong Court.—(I) Where on receiving an application it appears to the Court that it should be presented to another Court, it shall return it to the applicant after endorsing upon it the dates of the presentation and return, the reason for returning it and the name of the Court to which it should be presented. (3) The Court to which an application is transferred under sub-rule (2) may continue the proceedings as if the previous proceeding or any part of it had been taken before it, if it is satisfied that the interests of the parties will not thereby be prejudiced. (2) A copy of the application shall also be sent along with the summons under sub-rule (I).
Service of Summons or notice.— (I) A summon or notice may, on payment of the required fee, shall be sent by the Court by which it is issued, either by registered post or in such other manner as the Court think fit. (2) Every such written statement shall be verified in the same manner as a pleading in a Civil Court and shall be accompanied by two copies thereof.

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(3) In every written statement submitted under sub-rule (1) the opposite party shall deal specifically with each obligation of fact alleged by the applicant, of which he admits or does not admit or denies the truth. The written statement must also contain all matters which show that the application is not maintainable and all such grounds of defence as if not raised, would be likely to take the applicant by surprise or would raise issues of fact not arising out of the application as for instance, fraud, undue influence or coercion, release, payment performance or facts showing illegality of the transaction.
1. Failure to present written statement called for by the Court.— Where any party from whom a written statement is required fails to present the same within the time specified by the Court, the Court may pronounce judgement against it or make such order in relation to the proceeding as it thinks fit.
1. Framing of issues.- (I) At the first hearing of the application, after the summons is served, the Court shall, after considering the application and the written statement, if any, or after such examination of the parties or any persons or any document as may appear necessary, ascertain upon what material proposition of fact or of law the parties are at variance, and shall thereupon proceed to frame and record the issues upon which the right decision appears to depend.
(2) In recording the issues, the Court shall distinguish between those issues which in its opinion concerns points of fact and those which concern points of law.
(3) The Court may, in like manner, at any time, before passing its final order add to, strike out from or in any way amend the issues on such terms as it may think fit.
1. Order where parties are not at issue.— Where at any hearing of the case it appears that the parties are not at issue on any question of law or of fact the Court may at once pronounce its final order.
1. Appearance of parties and consequences of non-appearance.— (I) On the day fixed in the summons for the opposite party to appear and answer, the parties shall be in attendance at the Court in person or by their respective legal practitioners and the application shall then be heard unless the hearing is adjourned by the Court.
(2) When neither party appears when the application is called on for hearing, the Court may make an order that the application be dismissed.
(3) Where the opposite party appears and the applicant does not appear when the application is called on for hearing the Court shall made an order that the application be dismissed unless the opposite party admits the claim or part thereof in which case the Court shall make an order against the opposite party upon such admission and where part only of the claim has been admitted, it shall dismiss the case so far as it relates, to the remainder.
(4) Where the applicant appears and the opposite party receiving the summons fails to appear when the application is called on for hearing, the Court may proceed ex-parte.
(5) Where the application is wholly or partly dismissed under sub-rule (2) or (3), the applicant may within thirty days of such dismissal apply in Form-VI hereto for an order to set the dismissal aside and the Court shall, if it is satisfied that he was prevented from appearing when the proceeding was called on for hearing due to any sufficient cause make an order setting aside the dismissal upon such terms as to costs or otherwise as it thinks fit and may proceed with the case or appoint a day for proceeding with the same: Provided that no order under this sub-rule shall be made in respect of an application which is dismissed under sub-rule (3) unless notice of the application has been served in Form-VI on the opposite party.
(6) In any application in which an ex-parte order has been passed against the opposite party, he may within thirty days from the date of such order apply in Form-VII to the Court which passed the order, to set it aside and if the Court is satisfied, that he was prevented from appearing when the proceeding was called on for hearing due to any sufficient cause, it shall after serving notice thereof to the applicant in Form-VIII make an order setting aside the order upon such terms as it thinks fit and may proceed with, the hearing of the case or appoint a day for proceeding with the same.

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Summoning of witnesses.— (1) At any time, after the framing of the issues, the Court may call upon the parties to produce their evidence in support of the issues. (2) The Court may, on the application of either party, issue a summons in Form-VIII to any witness directing him to attend or to produce any document. (3) The Court may, before summoning any witness on application under sub-rule (2), require that his reasonable expenses to be incurred in attending the Court, be deposited with it.
Grant of time and adjournment of hearing.—(1) The Court may, if sufficient cause is shown, at any stage of the application grant time to the parties or to any of them, and may, from time to time adjourn the hearing of the application. (2) In every such adjournment the Court shall fix a day not exceeding fifteen days from the date on which such adjournment is made for the further hearing ill the application and may make such order as it thinks fit with respect to the costs occasioned by the adjournment: Provided that when the hearing of the evidence has once begun, the hearing of the application shall be, continued from day to day until all the witnesses in attendance have been examined, unless the Court finds the adjournment of the hearing beyond the following day to be necessary for reasons to be recorded.
Right to begin proceeding.— The applicant shall have the right to begin unless the opposite party admits the fact alleged by the applicant and contends that either in point of law or on some additional facts alleged by the opposite party, the applicant is not entitled to the relief which he seeks, in which case the opposite party shall have the right to begin.
Statement and production of evidence.—(1) On the day fixed for the hearing of the application or on any other day to which the hearing is adjourned, the party having the right to begin shall state his case and produce his evidence in support of the issues which he is bound to prove. (2) The other party shall then state his case and produce his evidence (if any) and may then address the Court generally on the whole case.
Method of recording evidence.— The evidence of each witness shall be taken down in writing by the Judge or where there is more than one Judge, by the Junior Judge in the language of the Court, not ordinarily in the form of question and answer, but in a narrative, and when completed, shall be read over or translated, where necessary, in the presence of such Judge and the witness, and such Judge shall, if necessary, correct the same and sign it.
Recall of a witness.— The Court may at any stage of a proceeding recall any witness who has been examined and may (subject to the law of evidence for, the time being in force) put such questions to him as the Court thinks fit.
Inspection by Court.— The Court may at any stage of a proceeding inspect any property or thing concerning which any question may arise.
Signing of order.— The final order shall be dated and signed in open Court, at the time of pronouncing it and, when once signed, shall not afterwards be altered or added to, save in the case of clerical or arithmetical mistake arising from any accidental slip or omission.

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Compromise of suit.— Where it is proved to the satisfaction of the Court that a case has been adjusted wholly or in part by any lawful agreement or compromise, or where the opposite party satisfies the applicant in respect of the whole or any part of the subject matter of the case, the Court shall order such agreement, compromise or satisfaction to be recorded, and shall pass a final order. in accordance therewith so far as it relates to the case.
Finality of Order.— The order of a Court shall be final and binding upon the parties.
Costs.— (i) The costs of and incidental to the application shall be in the discretion of the Court, and the Court shall have full power to determine by whom or out of which property and to what extent such Costs are to be paid, and to give all necessary directions for the purpose aforesaid. The fact that the Court has no jurisdiction to try the case shall be no bar to the exercise of such powers.
Contents of the decree.— (I) A decree in Form-IX hereto shall be prepared in conformity with the order made by the Court and shall contain the number of the application, the names and descriptions of the parties, and particulars of the claim, and shall specify clearly the relief granted or other determination of the proceeding. (2) The decree shall also state the amount of costs incurred in the proceeding and by whom and in what proportions such costs are to be paid. (3) The Court may direct that the costs payable to one party by the other shall be set off against any sum which is admitted or fund to be due from, the former to the latter.
Certified copies of order, decree, etc., to be furnished.— (I) Certified copies of the final order, decree or any other order or matter on record shall be furnished to the parties on application to the Court and at their expense. (2) If any party requires copies of any order, decree, or any other matter on record made by or furnished to the Court, as the case may be, to be supplied to him within forty-eight hours of the submission of an application thereof to the Court, he shall pay fee of two rupees for each such copy.
Execution.— (I) Any person in whose favour an order had been passed shall, within one year from the date of the order, apply in Form-X hereto to the Court which made the order for its execution. (2) On such application being made, the Court shall send the same together with the necessary record to a Civil Court, of competent jurisdiction, for the execution and such Civil Court shall have the same power in executing such order as if it has been passed by it.
Communication of fact of execution otherwise.— The Civil Court to which a decree is sent for execution shall certify to the Court which passed it the fact of such execution or where that Court fails to execute the same and the circumstances attending such failure.
Fees.—(1) The fee payable on an application in respect of any matter shall be two rupees. (2) Subject to the provisions hereafter mentioned in this rule, the fee payable in respect of any other application except a written statement called for by the Court under these rules shall be two rupee: Provided that the fee for an application for obtaining a copy or translation of any document or record or statement, order or decree before the Court, shall be one rupee. (3)The fee for filing certified copies of any document in a Court shall be one rupee. (4) All fees shall be collected by means of court fee stamps used in ordinary Courts and no document which ought to bear stamp shall be of any validity unless and until it is properly stamped:

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Provided that where any such document is through mistake or inadvertence, received, filed or used in a Court without being properly stamped, the Court may, if it thinks fit, order that such document be stamped as it may direct and on such document being stamped accordingly the same and every proceeding relative thereto shall be as valid as if it had been properly stamped in the first instance. (5) No document requiring a stamp under this rule shall be acted upon in any proceeding in a Court until the stamp has been cancelled. 61. Payment of costs of services of summons, etc.—(I) The cost of service of summons or notices or the expenses of the witnesses in any case or the fee payable in respect of any matter not referred to in the preceding rule shall be such amount as may be specified in each case by the Court, and such amount or any other sum of money payable under these rules shall be paid in such manner and within such time as it may specify therefor. (2) Any amount which is left over after meeting the expenses, if any, for which it was intended, shall be returned by the Court to the party by whom or on whose behalf the amount was originally paid to the Court. (3) The Court shall maintain proper accounts of the amount received and disbursed under sub-rule (l). 62. Fees and costs of poor persons.— The Court may, whenever it thinks fit, receive and register proceedings instituted under the Act and applications made under these rules, by persons who are paupers, and may issue summons or notices on behalf of such persons, without payment or on a part payment of the fees and costs. 63. Provisions in the Code of Civil Procedure, 1908 (V of 1908) etc., to apply.— In respect of matters relating to powers, procedure or admission of evidence for which no specific provision is made in these rules the provisions of the Code of Civil Procedure 1908 (V of 1908), including the Rules made there under and the Bharatiya Sakshya Adhiniyam, 2023 (Central Act, 47 of 2023) shall, so far as may be, apply to proceedings under the Act. 64. Manner and time within which second appeal may be filed to the Court.— The Insured person or the corporation may appeal to the Court by presenting an application within ninety days of the date of communication of the decision of the Medical Board or of the Medical Appeal Tribunal to the Insured Person or the Corporation, as the case may be: Provided that the Court may entertain an application after the period of ninety days, if it is satisfied that the appellant had sufficient reasons for not presenting the application within the said period.

CHAPTER IV

Gratuity

Gratuity invested for the benefit of minor.— In the case of nominee, or an heir, who is minor, the competent authority shall invest the gratuity amount deposited with him for the benefit of such minor in term deposit with the State Bank of India or any other Nationalised Bank. Explanation.—“Nationalised Bank” means a corresponding new bank specified in the First Schedule to the Banking Companies (Acquisition and Transfer of Undertakings) Act, 1970 (Central Act 5 of 1970) or a corresponding new bank specified in the First Schedule of the Banking Companies (Acquisition and Transfer of Undertakings) Act, 1980 (Central Act 40 of 1980).

(i) in the case of an employee who is already in employment for a year or more on the date of commencement of these rules but not submitted the nomination, ordinarily, within ninety days from such date; and

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(ii) in the case of an employee who completes one year of service after the date of commencement of these rules, ordinarily within thirty days of the completion of one year of service: Provided that nomination in Form-XI shall be accepted by the employer after the specified period, if filed and no nomination so accepted shall be invalid merely because it was filed after the specified period.
(2) Within thirty days of the receipt of nomination in Form-XI under sub-rule (I), the employer shall get the service particulars of the employee, as mentioned in the form of nomination, verified with reference to the records of the establishment, and return to the employee, after obtaining a receipt thereof, the duplicate copy of the nomination in Form-XI duly attested either by the employer or an officer authorised in this behalf by him, as a token of recording of the nomination by the employer and the other copy of the nomination shall be retained by him.
(3) An employee who has no family at the time of making a nomination shall, within ninety days of acquiring a family submit in the manner specified in sub-rule (I), a fresh nomination, as required under sub-section (4) of Section 55, in duplicate in Form-XI to the employer and thereafter the provisions of sub-rule (2) shall apply mutatis mutandis as if it was made under sub-rule (I).
(6) A nomination, fresh nomination or notice of modification of nomination shall take effect from the date of receipt thereof by the employer.
1. Application for payment of gratuity and appeal etc.—(I) An employee who is eligible for payment of gratuity under the Code, or any person authorized, in writing, to act on his behalf, shall apply, ordinarily within a period of thirty days from the date the gratuity became payable, in Form-XII hereto to the employer: Provided that where the date of superannuation or retirement of an employee is known, the employee may apply to the employer before thirty days of the date of superannuation or retirement:
(2) A nominee of an employee who is eligible for payment of gratuity under the second proviso to sub-section (I) of Section 53 shall apply, ordinarily within thirty days from the date of gratuity became payable to him, in Form-XII hereto to the employer:
(3) A legal heir of an employee who is eligible for payment of gratuity under the second proviso to sub-section (I) of Section 53, shall apply, ordinarily within one year from the date of gratuity became payable to him, in Form-XII to the employer.

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1. Notice for payment of gratuity.— (1) Within fifteen days of the receipt of an application for payment of gratuity, the employer shall—
(ii) if the claim for gratuity is not found admissible, issue a notice in Form-XIII to the applicant employee, nominee or legal heir, as the case may be, specifying the reasons why the claim for gratuity is not considered admissible, and the copy of the notice shall be endorsed to the competent authority.
(b) stock option benefits or cash equivalent of stock award:
(d) telephone and internet reimbursement; and
(4) A notice in Form-XIII shall be served on the applicant either by personal service after taking receipt or by registered post with acknowledgement due or electronically.
(5) As soon as the gratuity becomes payable, the employer shall, whether an application has been made or not, determine the amount of gratuity and give a notice under sub-section (2) of Section 56 in Form-XIII.
1. Mode of payment of gratuity.— The gratuity payable under the Code shall be paid through Demand Draft or by crediting in the bank account of the eligible employee, nominee or legal heir, as the case may be:

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Provided that intimation about the details of payment shall also be given by the employer to the competent authority of the area. 70. Application to competent authority for direction.—(I) If an employer—

(i) refuses to accept a nomination or to entertain an application sought to be filed, or
(ii) issues a notice either specifying an amount of gratuity which is considered by the applicant less than what is payable or rejecting eligibility to payment of gratuity, or the claimant employee, nominee or legal heir, as the case may be, may, within one hundred eighty days of the occurrence of the cause for the application, apply in Form-XIV hereto to the Competent Authority for issuing a direction under Clause (c) of sub-section (5) of Section 56 with a copy to the opposite party. Provided that the competent authority may accept any application under this sub-rule, on sufficient cause being shown by the applicant, after the expiry of the specified period.
(2) Application under sub-rule (I) and other documents relevant to such an application shall be presented in person to the competent authority or shall be sent by registered post acknowledgement due or electronically.
1. Procedure for dealing with application for direction.— (I) On receipt of an application under rule 54 the Competent Authority shall, by issuing a notice in Form-XV electronically or registered post acknowledgment due or in person call upon the applicant as well as the employer to appear before him on a specified date, time and place, either by himself or through his authorized representative together with all relevant documents and witnesses, if any.
(2) Any person desiring to act on behalf of an employer or employee, nominee or legal heir, as the case may be, shall present to the competent authority a letter of authority from the employer or the person concerned, as the case may be, on whose behalf he seeks to act together with a written statement explaining his interest in the matter and praying for permission so to act. The competent authority shall record thereon an order either according his approval or specifying, in the case of refusal to grant the permission prayed for, the reasons for the refusal.
(3) A party appearing by an authorized representative shall be bound by the acts of the representative.
(4) After completion of hearing on the date fixed under sub-rule (I), or after such further evidence, examination of documents, witnesses, hearing and inquiry, as may be deemed necessary, the competent authority shall record his finding as to whether any amount is payable to the applicant under the Code and a copy of the finding shall be given to each of the parties.
(7) The competent authority may authorize a clerk of his office to administer oaths for the purpose of giving evidence or producing documents.

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(c) Any record, other than a record of any order or direction, which is required to be signed by the competent authority, may be signed on behalf of and under the direction of the competent authority by any subordinate officer appointed in writing for this purpose by the competent authority.
(b) The Memorandum of appeal shall contain the facts of the case, the decision of the competent authority, the grounds of appeal and the relief sought.
(h) On receipt of the decision of the appellate authority, the competent authority shall, if required under that decision, modify his direction for payment of gratuity and issue a notice to the employer concerned in Form XVI specifying the modified amount payable and directing payment thereof to the applicant, under intimation to the competent authority within fifteen days of the receipt of the notice by the employer and a

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copy of the notice be endorsed to the appellant/employee, nominee or legal heir, as the case may be, and to the appellate authority.

(14) Where an employer fails to pay the gratuity due under the Code in accordance with the notice by the competent authority under sub-rule (1) or sub-rule (12), as the case may be, the employee concerned, his nominee or legal heir, as the case may be, to whom the gratuity is payable may apply to the competent authority in duplicate in Form-XVII hereto for recovery thereof under Section 129 of the Code. (15) The person to be appointed as a competent authority for the purposes of chapter V of the Code shall be an officer not below the rank of Deputy Labour Commissioner of the Labour Department, having degree in law or diploma in labour laws of a university established by law in any part of India and at least seven years experience as conciliation officer in the Department.

CHAPTER V

MaternityBenefity

1. Certificate and notice of claim for maternity benefit.— (I) (a) The fact that a woman is pregnant or has been delivered of a child or has undergone miscarriage or medical termination of pregnancy or tubectomy operation or is suffering from illness arising out of pregnancy, delivery, premature birth of a child or miscarriage or medical termination of pregnancy or tubectomy operation shall be proved by the production of a certificate in Form-XVIII, from—
(i) a registered medical practitioner; or
(c) The fact that a woman has undergone miscarriage may also be proved by the production of a certificate signed by a qualified Auxiliary Nurse and Midwife.
(d) The fact of death of a woman or a child may be proved by the production of a certificate to that effect in Form-XVIII from any of the authorities referred to in Clause (a), or by the production of a certified extract from a death register maintained under the provisions of any law for the time being in force.
(2) (a) A woman employed in an establishment and entitled to maternity benefit shall give notice to her employer in Form-XIX and the employer shall make payment of the maternity benefit and any other amount due under the Code to the woman concerned, or, in case of her death before receiving such maternity benefit or amount, or where the employer is liable for maternity benefit under the second proviso to sub-section (3) of Section 60, to the person nominated by the woman in her notice in Form-XIX and in case there is no such nominee to her legal representative: Provided that an application in plain paper or electronically with relevant particulars may be accepted by an employer at his discretion instead of Form-XIX: Provided further that no claim shall be invalid merely because the claimant failed to present her application in specified form.
(b) In case of doubt, the maternity benefit or other amount due to a woman employed in an establishment shall be deposited by the employer, within two months of the date of death of the woman concerned with the competent authority, who shall, after making necessary enquiries as it may think fit, pay it to the person who, in his opinion, is entitled to receive it.

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(c) Whenever the payment referred to in Clause (a) is made, a receipt shall be obtained by the employer in Form-XIX from the person to whom the payment is made and in cases falling under Clause (b), a receipt shall be given to the employer by the competent authority.
(d) The medical bonus shall be paid along with the second instalment of the maternity benefit.
(e) The maternity benefit or any other amount payable under Section 63 shall be paid within two months of the date of death of the woman entitled to receive such benefit or amount.
(f) The wages payable under Section 65 shall be paid to the woman entitled to receive such wages within forty-eight hours of production of the certificate in Form-XVIII by her.
(iv) The working hours of crèche shall correspond to the working hours of the employees and it may work in shifts;
(v) Every creche shall be in the charge of a woman with midwifery qualification or training as creche attendant and where the number of children exceeds ten, the creche attendant shall be assisted by female ayahs at the rate of one ayah for every ten children up to six years;
(vi) the creche shall have sufficient number of cots, beds, cotton sheets, rubber sheets, blankets, pillows, toys, and like other things for children;
(vii) (a) every crèche shall have suitable arrangement for female employees to feed their children below fifteen months of age during the intervals;
(b) adequate number of bathrooms, toilets, washbasins, clean towels and soap shall be provided in the crèche;
(c) the crèche shall have first aid facility kept in proper condition under the supervision of trained female staff;
(d) there shall be a kitchen attached to the crèche with utensils and other facilities for boiling milk and preparing refreshments and like other things; and
(e) drinking water, milk and wholesome refreshment shall be available for the children at the crèche;
(viii) (a) In any establishment where there is a sole negotiating union under sub-section (2) or (3) of Section 14 of the Industrial Relations Code, 2020 (35 of 2020) or a negotiating council under sub-section (4) of Section 14 of the Industrial Relations Code, 2020 (35 of 2020), then, such negotiating union or negotiating council, as the case may be, may enter into an agreement with the employer of the establishment that the crèche facility under section 67 shall be provided, if women or widower or single parent employees, who are having children below the age of six years and eligible to get crèche facility and if not provided, then, such employee shall be paid crèche allowance every month by that establishment.
(b) Where there is no sole negotiating union or negotiating council referred to in sub-clause (a), the majority of the employees of the establishment may enter into an agreement with the employer of the establishment that the crèche facility under Section 67 shall be provided, if women or widower or single parent employees, who are having children below the age of six years and eligible to get crèche facility and if not provided, then, such employee shall be paid crèche allowance every month by that establishment.

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Provided further that the crèche allowance shall be admissible for two children only except when the number of children exceeds two due to second child birth resulting in multiple births.

(5) In case the employer fails to submit his reply or produce the required documents within the specified period, the competent authority may give his decision ex-parte.
(b) When a complaint referred to in sub-rule (I) is received by an Inspector-cum-Facilitator, he shall examine the relevant records maintained by the employer in this behalf, examine any person employed in the establishment and take down necessary statement for the purpose of the enquiry and if he is satisfied that the maternity benefit or the amount has been improperly withheld or discharged or dismissed, he shall direct the employer to make the payment to the complainant or to the person claiming the payment under Section 63, and pass such order as he deems fit, immediately but not exceeding period of 45 days, from the date of -------
(2) (a) An appeal against the decision of the Inspector-cum-Facilitator, shall lie to the competent authority.
(b) The aggrieved person shall prefer an appeal in writing to the competent authority in Form-XXI B and file other supporting documents.
1. Duties of Inspector-cum-Facilitator.— (I) Every Inspector-cum-Facilitator, shall at each inspection of an establishment, see,—
(i) whether due action has been taken on every notice given under Section 62;
(ii) whether the register of women employees is correctly maintained:
(iii) whether there have been any cases of discharge or dismissal or notices of discharge or dismissal in contravention of the provisions of section 68 since the last inspection;
(iv) whether the provisions of sub-section (1) of Section 59, sub-sections (5) and (6) of Section 62, Sections 64, 65, 66, 67, 69 and 71 have been complied with and whether amounts due have been paid within the time as per the relevant provisions of the Code and rules made by the Central Government;
(v) whether there have been any cases of deprival of maternity benefit or medical bonus as referred to in sub-section (2) of Section 68; and

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(vi) how far the irregularities pointed out at previous inspections have been remedied and how far orders previously issued have been complied with.
(4) Nothing shall affect the right of a woman entitled to receive maternity benefit or any other amount due under the Code if she fails to submit a notice, appeal or complaint under the said rules, as the case may be, in a form specified for such purpose: Provided that where a notice, appeal or complaint under the said rules has been submitted by a woman entitled to receive maternity benefit or any other amount due under the Code in a form other than the form specified for such purpose, the authority concerned may, 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 form specified for such purpose.
(5) The abstract of the provisions of Chapter VI of the Code and the Central rules made thereunder required to be exhibited under Section 71 shall be in Form-XXII, and shall be exhibited in such manner as the competent authority may require.

CHAPTER VI

Employees Compensation

(a) by the employer. on the ground that since the right to compensation was determined, the employee’s wages have increased;
(b) by the employee, on the ground that since the right to compensation was determined, his wages have diminished;
(c) by the employee, on the ground that the employer, having commenced to pay compensation, has ceased to pay the same, notwithstanding the fact that there has been no change in the employee's condition such as to warrant such cessation;
(d) either by the employer or by the employee, on the ground that the determination of the rate of compensation for the time being in force was obtained by fraud or undue influence or other improper means;
(e) either by the employer or by the employee on the ground that in the determination of compensation, there is a mistake or error apparent on the face of the record.

Procedure on application for review.— If, on examining an application for review by an employer in which the reduction or discontinuance of half-monthly payments is sought it appears to the Competent Authority that there is reasonable ground for believing that the employer has a right to such reduction or

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discontinuance, he may at any time issue an order withholding the half-monthly payments in whole or in part pending his decision on the application. 80. Procedure on application for communication.— (I) Where application is made to the Competent Authority under section 80 for redemption of a right to receive half-monthly payments by the payment of a lump sum, the Competent Authority shall from an estimate of the probable duration of the disablement, and shall award a sum equivalent to the total of the half-monthly payments which would be payable for the period during which he estimates that the disablement will continue, less one-half per cent of that total for each month comprised in that period: Provided that fraction of a rupee included in the sum so computed shall be disregarded. (2) When, in any case to which sub-rule (I) applies, the Competent Authority is unable to form an approximate estimate of the probable duration of the disablement, he may from time to time postpone a decision on the application for a period not exceeding two months at any one time. 81. Class of employers and the form of notice-book.— Every employer to which the Code applies, shall maintain a notice book in accordance with sub-section (4) of Section 82 in Form-XXIII, which shall be readily accessible at all reasonable times to any injured employee employed on the premises, and to any person acting bonafide on his behalf. Provided that—

(i) the time so specified shall not, save with the express consent of the employee, be between the hours of 7.00 p.m. and 6.00 a.m.; and
(iii) Restriction on number of examinations.— A employee who is in receipt of a half-monthly payment shall not be required to submit himself for medical examination elsewhere than at the place where he is residing for the time being more than twice in the first month following the accident or more than once in any subsequent month.
(vi) Examination after suspension of right to compensation.— If a employee whose right to compensation has been suspended under sub-section (2) or sub-section (3) of Section 84 subsequently offers himself for medical examination, his examination shall take place on the employer's premises or at such other place in the vicinity as may be fixed by the employer, and at a time to be fixed by the employer

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not being save with the express consent of the employee, more than 72 hours after the workman has so offered himself.

(v) Examination of women.— (a) No woman shall without her consent be medically examined by a male practitioner, save in the presence of another woman.
1. Form of statement to be submitted by the employer.— The statement for fatal accident required under sub-section (I) of Section 88, shall be in Form-XXIV hereto. Provided that the notice may be communicated orally to any parties who are present at the time when notice in writing would otherwise issue.
(3) On the date so fixed, the competent authority, after hearing the parties to agreement shall take decision to record or refuse to record the memorandum:
(5) If, on receiving a memorandum of agreement, the Competent Authority considers that there are grounds for refusing to record the same he shall fix a date for hearing the party or parties desiring the memorandum to be recorded, and shall inform such party or parties and, if he thinks fit, any other party concerned of the date so fixed, and of the ground on which he considers that the memorandum should not be recorded.

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(II) Where in case of the agreement for the redemption of half-monthly payments by the payments of a lump sum, the Competent Authority considers the memorandum of agreement should not be recorded by reason of the inadequacy of the amount of such sum as filed in the agreement, he shall record his estimate of the probable duration of the disablement of the employee.
(12) In recording a memorandum of agreement, the competent authority shall cause the same to be entered in a register in Form-XXXI hereto and shall cause an endorsement to be entered under his signature on a copy of a memorandum to be retained by him in the following terms, namely:- "The memorandum of agreement bearing Serial No. ________ of ____20 in the register has been recorded this __________ day __________ of.
1. Experience and qualification for appointment as a competent authority under sub-section (1) of Section 91.— The Government may, by notification, appoint any person who is or has been—
1. Manner in which matters may be dealt with by or before a competent authority.— (I) Application.— (I) Any application under Section 93 may be filed before to the competent authority electronically or by registered post or may be presented to him or to any of his subordinates authorized by him in this behalf, and, if so sent or presented, shall, unless the Competent Authority otherwise directs, be made in duplicate in appropriate Form, if any, and shall be signed by the applicant.
(3) When the application for relief is based upon a document, the document shall be accompanied with the application.
(5) Any document which is not produced shall not, without the sanction of the Competent Authority, be admissible in evidence on behalf of the party who should have produced it.
(6) Nothing in this sub-rules applies to any document which is produced for the purpose of cross-examining a witness or is handed to a witness to refresh his memory.
(7) If it appears to the Competent Authority on receiving application that it should be presented to another Competent Authority he shall return it to the applicant after endorsing upon it the date of their presentation and return, the reasons for returning it and designation of the Competent authority to whom it should be presented.
(8) If it appears to the Competent Authority at any subsequent stage that an application should have been presented to another Competent Authority, he shall send the application to the Competent Authority empowered to deal with it and shall inform the applicant (and the opposite party, if he has received a copy of the application), accordingly.
(9) The Competent Authority to whom an application is transferred under sub-rule (8) may continue the proceedings as if the previous proceedings or any part of them has been taken before him, if he is satisfied that the interests of the parties will not thereby be prejudice.

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such officer to examine the applicant and his witness and forward the record thereof to the Competent Authority. The substance of any examination made shall be recorded in the manner provided for the recording of evidence in Section 97.

(II) The Competent Authority may, after considering application and the result of any examination of the applicant, summarily dismiss the application, if, for reasons to be recorded, he is of opinion that there are no sufficient grounds for proceeding thereon. The dismissal of the application shall not be itself preclude the applicant from presenting a fresh application for the settlement of the same matter.**
(12) If the application is not dismissed under sub-rule (ii), the Competent Authority may for reasons to be recorded, call upon the applicant to produce evidence in support of the application before calling upon any other party, and, if upon considering such evidence the Competent Authority is of opinion that there is no case for the relief claimed, he may dismiss the application with a brief statement of his reasons for so doing.
(13) the Competent Authority does not dismiss the application under sub-rule (12), he shall send to the party from whom the applicant claims relief (hereinafter referred to as the opposite party) a copy of the application, together with a notice of the date on which he will dispose of the application, and may call upon the parties to produce upon that date any evidence which they may wish to tender. The opposite party may, and if so required by the Competent Authority, at or before the first hearing or within such time as the Competent Authority may permit, file a written statement dealing with the claim, raised in the application, and any such written statement shall form part of the record. If the opposite party contests the claim, the Competent Authority may, and if no written statement has been filed, shall proceed to examine him upon the claim and shall reduce the result of examination to writing.
(14) After considering any written statement and the result of any examination of the parties, the Competent Authority shall ascertain upon what material propositions of fact or of law the parties are at variance and shall thereupon proceed to frame and record the issues upon which the right decision of the case appears to him to depend. In recording the issues, the Competent Authority shall distinguish between those issues which in his opinion concern point of facts and those which concern point of law.
(17) If the Competent Authority finds it impossible to dispose of an application at one hearing he shall record the reasons which necessitate a postponement.
(19) If an application is presented by any party to the proceedings for the citation of witnesses, the Competent Authority shall, on payment of the specified expenses, and fees, issue summons for the appearance of such witnesses, unless he considers that their appearance is not necessary for the just decision of the case.
(20) A Competent Authority before whom any proceeding relating to injury by accident is pending may, at any time, enter the place where the workman was injured, or where the workman ordinarily performed this work, for the purpose of making a local inspection or of examining any person likely to be able to give information relevant to the proceedings:

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Any party, or the representative of any party, may accompany the Competent Authority at a local inspection.

(22) (a) The Competent Authority during a local inspection or at any other time, save at a formal hearing of a case pending before him, may examine summarily any person likely to be able to give information relative to such case, whether such person has been or is to be called as a witness in the case or not, and whether any or all the parties are present or not.
(b) No oath shall be administered to a person to be examined under Clause (a).
(c) Statements made by persons examined under Clause (a), if reduced to writing, shall not be signed by the person making the statement, nor shall they, except as hereinafter provided, be incorporated in the record or utilized by the Competent Authority for the purpose of arriving at a decision in the case.
(e) Any statements or part of a statement which is furnished to the parties under Clause (d) shall be incorporated in the record.
(f) Where a case is settled by agreement between the parties, the Competent Authority may incorporate in the record any statement made under Clause (a) and may utilize such statement for the purpose of justifying his acceptance of or refusal to accept the agreement reached.
(23) (a) If a party states in writing his willingness to abide by the decision of the Competent Authority, the Competent Authority shall inquire whether the other party is willing to abide by his decision.
(b) If the other party agrees to abide by the Competent Authorities’ decision, the fact of his agreement shall be recorded in writing and signed by him.
(c) If the other party does not agree to abide by the Competent Authorities decision the first party shall not remain under an obligation so to abide.
(24) (a) Where the opposite party claims that if compensation is recovered against him he will be entitled under sub-section (2) of Section 85 to be indemnified by a person not being a party to the case, he shall, when first called upon answer the application, present a notice of such claim to the Competent Authority accompanied by the fee of Rs.500/-, and the Competent Authority shall thereupon issue notice to such person in Form-XX hereto.
(b) If any person served with a notice under Clause (a) desires to contest the applicant’s claim for compensation or the opposite party’s claim to be indemnified, he shall appear before the Competent Authority on the date fixed for the hearing of the case or on any date to which the case may be adjourned

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(d) If any person served with a notice under Clause (c) desires to contest the applicant’s claim for compensation, or the claim under Clause (c) to be indemnified, he shall appear before the Competent Authority on the date fixed in the notice in Form-XXXIV or on any date to which the case may be adjourned and , if he so appears, shall have all the rights of a party to the proceedings in default of so appearing he shall be deemed to admit the validity of any award made against the original opposite party or the person served with a notice under Clause (a) and to admit his own liability to indemnify the party against whom such award is made for any compensation recovered from him:
(e) In any proceeding in which a notice has been served on any person under Clause (a) or Clause (c) the Competent Authority shall, if he awards compensation, record in his judgment a finding in respect of each of such persons, whether he is or is not liable to indemnify any of the opposite parties, and shall specify the party, if any whom he is liable to indemnify.
(b) Where action is taken under Clause (a) the evidence bearing on the common issue or issues shall be recorded on the record of one case, and the Competent Authority shall certify under his hand on the record on any such other case, the extent to which the evidence so recorded applied to such other case, and the fact that the parties to such other case had the opportunity of being present, and if they were present, of cross-examining the witnesses.
(26) Save as otherwise expressly provided in the Code or these Rules the following provision of the First Schedule to the Code of Civil Procedure, 1908, namely, those contained in Order V, rules 9 to 13 and 15 to 30; Order IX; Order XIII rules 3 to 10; Order XVI rules 2 to 21; Order XVII; and Order XXIII rules 1 and 2; shall apply to proceedings before Competent Authority, in so far as they may be applicable thereto: Provided that—
(a) For the purpose of facilitating the application of the said provisions, the Competent Authority may construe them with such alterations not affecting the substance as may be necessary or propose to adapt them to the matter before him;
(b) The Competent Authority may for sufficient reasons, proceed otherwise than in accordance with the said provisions if he is satisfied that the interests of the parties will not thereby be prejudiced.
(27) Any form other than a receipt for compensation, which is by these rules required to be signed by a Commissioner (Labour and Employment) may be signed under his direction and on his behalf by any officer subordinate to him appointed by him in writing for this purpose.
(29) (a) The competent authority shall dispose the application within six months from the date of receiving the application.
(b) Any party to the dispute who desires to get certified copies of decision, decree or other document, may get the same on payment of cost at the following rate, namely:—
(i) the cost for a copy of any document or record or statement or order or decree shall be rupees hundred per copy.
(ii)the cost of service or summons or notices or expenses of witnesses or the cost payable in respect of any of the matter not referred above shall be such amount as may be ordered in each case by the competent authority.
(c) The competent authority may, whenever it finds either on application of applicant or otherwise that the applicant is unable to pay the costs, it may exempt the applicant from the payment of cost.
(d) Any person who is not a party to dispute, may get the certified copy of decision, decree or other document except the confidential document, on payment of fee as specified above.
(30) (a) Upon receiving the application under Section 93, the competent authority may examine the applicant on oath or may send the application to any officer authorised by notification in this behalf and direct such officer to examine the applicant and his witness and forward the record thereof to the competent authority.
(b) Every employer, within a period of sixty days of commencement of his work or payment of cess, as the case may be, furnish to the assessing officer information in Form-XXXV.
(c) Any change or modification in the information furnished under Clause (b) shall be communicated to the assessing officer in Form-XXXV, incorporating details of such modification immediately not later than thirty days from the date of affecting the modification or change.
(d) For the purpose of self-assessment of cost of construction, the employer shall calculate the cost of construction work on the uniform rate or rates of construction as specified by Public Works Department (PWD) or the Central Public Works Department (CPWD) or any other schedule of rates applicable to such building or construction work or rates as per return or document submitted to the Real Estate Regulatory Authority for a building work (where Real Estate Regulatory Authority is applicable), applicable for that particular year in which commencement of building or other work took place in Form-XXXVI.
(e) where the duration of the project or construction work exceeds one year, cess shall be paid within thirty days of completion of one year from the date of commencement of work and every year thereafter at the notified rates on the cost of construction incurred during the relevant period.
(f) where the levy of cess pertains to building and other construction work of a Government or of a Public sector undertaking, such Government or the Public Sector Undertaking shall deduct or cause to be deducted the cess payable at the notified rate from the bill paid for such works.

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(g) where the approval of the construction work by a local authority is required, every application for such approval shall be accompanied by a cross demand draft in favour of the Board and payable at the station at which the Board is located for an amount of cess payable at the notified rate on the estimated cost of construction: Provided that if the duration of the project is likely to exceed one year, the demand draft may be for the amount of cess payable on cost of construction estimated to be incurred during one year from the date of commencement and further payment of cess due shall be made as per the provisions of Clause (e).
(h) An employer may pay in advance an amount of cess calculated on the basis of the estimated cost of construction alongwith the notice of the commencement of the work by a crossed demand draft in favour of the Board and payable at the station at which the Board is located.
(i) In case, there is any stoppage or reduction of building or other construction work, employer shall furnish the information in Form-XXXVII, to the assessing officer within sixty days of such stoppage or reduction of building or other construction work.
(m) The amount so collected shall be transferred to such Board’s fund within thirty days of its collection through online payment system.
(n) The Goa Building Workers' Welfare Board shall periodically reconcile the amount of cess collected, with the concerned authorities of the State Government or Central Government or Public Sector Undertaking of the State Government or the Central Government or any such other authority as specified by the appropriate Government.
(o) The Goa Building Workers’ Welfare Board shall submit half-yearly report, to the State Government with a copy to the Central Government, on the amount of cess collected, cumulative and during the period, expenditure incurred during the period, number of live building or other construction workers, for such period and with such details, as specified by the Central Government.
(p) The assessing officer, on receipt of information of return and cess paid from an employer in Form-XXXVIII, may make a scrutiny of such information furnished and, if he is satisfied about the correctness of the particulars so furnished, he shall make an order of assessment within a period not exceeding one hundred and eighty days from the date of receipt of such information, indicating the amount of cess payable by the employer and endorse a copy thereof to the employer and to the cess-collector and to the Goa Building Workers’ Welfare Board and despatch such order within five days of the date on which such order is made: Provided that such scrutiny shall be done by the assessing officer only where the amount of cess based on self-assessment exceeds rupees ten lakh: Provided further that if the assessing officer fails to make the order of assessment within a period of one hundred and eighty days, the self-assessment shall be deemed to be final.
(q) The order shall, inter-alia, specify the amount of cess due, cess already paid by the employer or deducted at source and the balance amount payable and the date, consistent with the provision of Clause (2), by which the cess shall be paid to the cess collector.
(r) If on the scrutiny of information furnished by the employer in Form-XXXVIII, the Assessing Officer is of the opinion that employer has under-calculated or miscaculated the cost of construction or has

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(s) On receipt of such notice the employer shall furnish to the Assessing Officer a reply together with copies of documentary or other evidences in support of his claim, within thirty days of the receipt of the notice: Provided that the Assessing Officer may, in the course of assessment afford an opportunity to the assessee to be heard in person, if he so requests to substantiate his claim.
(i) If the employer fails to furnish the reply within the stipulated period specified under Clause (s) or where any employer fails to furnish information in Form-XXXVIII, the Assessing Officer shall proceed to make the assessment on the basis of the available records and other information incidental thereto.
(u) The assessing officer may, at any time while the work is in progress or in the process of assessment of cost of construction authorise such officer to make such enquiry at the work site or from documentary evidence or in any other manner as he may think fit for the purpose of estimating the cost of construction as accurately as possible.
(w) The Assessing Officer, on receipt of information in Form-XXXVII from an employer shall make a scrutiny of such information furnished and, if he is satisfied about the correctness of the particulars so furnished, he shall make an order of assessment within a period not exceeding thirty days of receipt of such information.
(x) Following the assessment order made on receipt of Form-XXXVII as per Clause (w), the assessing officer shall, wherever necessary, endorse a copy of the such assessment to the Goa Building Workers' Welfare Board, cess collector and to such other persons as he thinks appropriate, for making the refund of excess cess as ordered in the assessment made under Clause (w).
(y)The Goa Building Workers’ Welfare Board shall, within thirty days of receipt of the endorsement from the assessing officer under Clause (x), refund the amount specified in the order to the employer through electronic payment system in the bank account as per details furnished by the employer for that purpose.
(z) Where the appellate authority has modified the order of assessment reducing the amount of cess, refund shall be made within such time as may be specified in that order or in the manner and time as specified under Clause (x).
(32) (a) Date of payment of cess shall be the date on which the amount is deposited with the cess collector or the date on which the amount has been deposited with the local authority, as the case may be.
(b) If any employer fails to pay any amount of cess payable under section 100, within such time as may be specified in the assessment order, such employer shall be liable to pay interest on the amount of cess, to be paid, at the rate of one per cent. for every month or part of a month comprised in the period from the date on which such payment was due till such amount is actually paid.

Provided that before imposing any such penalty, such employer shall be given a reasonable opportunity of being heard and if after such hearing the assessing officer is satisfied that the default was for any good and sufficient reason, no penalty shall be imposed on such employer.

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1. (a) An appeal under Section 105, inter alia, shall be accompanied with—
(a) the order appealed against;
(b) a certificate from the cess collector to the effect that the amount of cess or penalty or both, as the case may be, relating to such appeal has been deposited;
(c) a non-refundable fee equivalent to one-half per cent., but not exceeding rupees twenty five thousand of the amount in dispute or penalty or both, as the case may be, under such appeal;
(d) a statement of points in dispute; and
(e) documentary evidence relied upon.
(b) On receipt of the appeal, the appellate authority may, call details from the assessing officer or his statement on the basis of his assessment order appealed against, as such appellate authority may consider necessary for the disposal of such appeal.
(c) The appellate authority shall give the appellant an opportunity of being heard in the matter and dispose of the appeal as expeditiously as possible but not exceeding sixty days from the date of receipt of such appeal.
(d) On being satisfied on the quantum of cess, the appellate authority shall confirm the order of the assessing officer or if in his opinion the assessment was wrong; or on the higher side shall modify the order of assessment or if in his opinion the assessment is on the lower side or if the basis of assessment is wrong, it shall remand back the assessment order to the assessing officer along with his observations to rectify the wrong.
(e) An order remanded back shall be disposed of by the assessing officer within thirty days in view of the observation made by the Appellate Authority: Provided that, if the amount of cess is proposed to be enhanced the assessee shall be given an opportunity of being heard.
(f) If the appellate authority is of the opinion that the quantum of penalty imposed is on the higher side or not correctly made it shall suitably modify or set aside the order of the assessing officer, as he deems appropriate.
(g) The appeal under this rule shall be disposed of by making a speaking order and a copy of such order shall be sent to each of the appellant, the assessing officer and to the Secretary, Goa Building Workers’ Welfare Board within five days of the date on which such order is made. An order in appeal, reducing the amount of cess, shall also ask the Secretary, Goa Building Workers’ Welfare Board to refund the excess cess stating clearly a specified time to the appellant. An order in appeal enhancing or reducing the amount of cess or penalty or both, as the case may be, shall also specify the date by which the amount of cess or penalty or both shall be paid or refunded. No appeal shall lie against the order of the appellate authority under this rule.
1. Registration of building worker.— (1) Every employer or the contractor shall be responsible to register such building workers eligible under this rule who are on their muster roll on the portal of the State Government or the State Goa Building Workers’ Welfare Board or the designated Portal or in any other mode and such registration shall be seeded with Aadhaar and the Universal Account Number or any other such unique number generated through the designated Portal of the State Government. Provided that every such building worker has completed eighteen years of age and is less than sixty years of age and has been engaged in building or other construction work for not less than ninety days in

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the preceding twelve months.

(3) Every building worker registered with the Goa Building Workers’ Welfare Board, shall be entitled to receive the benefits provided by the Board from its fund during the validity period of such registration.
(4) The delivery of welfare schemes for the building workers may be done electronically using the registration number of the building worker and any cash assistance shall be given through direct benefit transfer only.
1. Recovery of due.— (I) For the purpose of recovery of sums due on account of unpaid cess, interest or overdue payment or, penalty under these rules, the assessing officer shall prepare a certificate signed by him, specifying the amount due and send it to the recovery officer of the district concerned who shall proceed to recover from the said employer the amount specified there under as if it were an arrears of land revenue or under any other such law prevailing for such purpose.
(2) An assessing officer, for the purposes of Section 103, may—
(a) enter any establishment where building or other construction work is going on only with the prior approval of the Secretary, Goa Building Workers’ Welfare Board;
(b) make an inventory of materials, machinery or other articles lying at the workplace;
(c) enquire about the number of workers engaged in various activities;
(d) require the production of any concerned register or any other documents relevant to the assessment of cost of construction or number of workers employed;
(e) seize or take copies of any such records;
(g) measurement, notes or photographs; and
(h) exercise such other powers considered absolutely necessary for reasonable assessment of cost of construction.
(3) The assessing officer or any Inspector-cum-Facilitator under the Code, having come to know of violation of an obligation to furnish return, furnishing of false information, intentionally or wilfully evading or attempting to evade the payment of cess may make a complaint with evidences pertaining to such complaint to the State Government with a copy to the Goa Building Workers’ Welfare Board in writing.
1. Fees for appeal.—An appeal preferred under sub-section (I) of Section 105 shall be accompanied by non-refundable fee equivalent to half percent, but not exceeding rupees twenty five thousand, of the amount in dispute or penalty or both, as the case may be, under such appeal.
1. Conditions and manner of writing off irrecoverable dues.— Where the Goa Unorganized Workers Social Security Board or the Goa Building and other Construction Workers Welfare Board is of the opinion that the amount of contribution, cess, interest and damages due to the Board has become irrecoverable, the Board or any other officer authorised by it in this behalf, may sanction the writing off of the said amount, subject to the following conditions, namely:—
(I) if the establishment has been closed for more than five years and the whereabouts of the employer cannot be ascertained, despite all possible efforts; or
(2) decree obtained by the Board could not be executed successfully for want of sufficient assets of the defaulting employer; or
(3) claim for contribution is not fully complied with by—

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ог

(b) in the event of factories or establishment being Nationalised or taken over by the Government.

Maintenance of Records, Registers, Returns, etc.

(2) The employer may enter in the register of women employees such other particulars as may be required for any other purpose of the Code. (4) The employer of every establishment in which employees are employed, shall prepare and maintain record and registers as per the record and registers to be maintained under the Code on Wages, 2019 (Central Act 29 of 2019) and the rules framed there-under. (5) The employer to which the provisions of the Code applies, on or before the 1st day of February in each year, upload a unified annual return in Form-XXXX hereto online on the web portal of the Labour Department of the Government of Goa, 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 records, register and other documents maintained in electronic form or otherwise. Explanation.— (a) For the purposes of this sub-rule, 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 (Central Act 21 of 2000). 92. Holding property, etc., by Social Security Organisation in accordance with Section 120.— The conditions to acquire, hold, sell or otherwise transfer any movable or immovable property under sub-section (1), conditions to re-invest or realize investments under sub-section (2), term to raise loans and take measures for discharging such loans under sub-section (3) and terms to constitute for the benefit of officers and staff or any class of them, provident or other benefit funds under sub-section (4) of Section 120 of the Code on Social Security shall be as decided by the Board by a resolution approved by not less than 2/3rd majority: Provided that all moneys held and belonging to the fund may be invested in Nationalized Banks or Scheduled Banks or in the securities as notified by the Government of Goa.

CHAPTER VIII

Employment Exchange

Manner and form of reporting vacancies and form of filing the return by the employer, to the concerned career centre.— (I) The employer in every establishment in public sector in the State of Goa shall, before filling up any vacancy in any employment in that establishment, report that vacancy or cause

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to be reported, to such Career Centre as may be specified in the notification by the Appropriate Government.

(2) The employer in every establishment in private sector or every establishment pertaining to any class or category of establishments in private sector shall, before filling up any vacancy in any employment in that establishment, report that vacancy or cause to be reported, to such Career Centre (Regional) from such date as may be specified in the notification by the Government. Explanation.— (I) Establishment in “public sector” means an establishment owned, controlled or managed by—
(i) the Government or a Department of the Government;
(ii) a Government company as defined in Clause (45) of Section 2 of the Companies Act, 2013 (No. 18 of 2013);
(2) “Establishment in private sector” means an establishment which is not an establishment in public sector and with ordinarily 20 or more employees or such number of employees as may be notified by the Central Government.
(4) Appropriate Government would be Central Government for Career Centre(Central) and Government of Goa for Career Centre (Regional).
(5) The vacancies shall be reported in writing or through valid official email or digitally to the Career Centre specified by the Government.
(6) The vacancies shall be reported in Form-XXXXI hereto furnishing as many details as practicable, separately in respect of each type of vacancy.
(7) Any change in the particulars already furnished to the Career Centre shall be reported in writing or through official email or digitally, as the case may be, to the specified Career Centre.
(8) (a) Vacancies, required to be reported to the Career Centre (Regional), shall be reported at least fifteen days before the last date of receipt of the applications of the prospective candidates for purpose of appointment or taking interview or test against the vacancies reported.
(b) Vacancies required to be reported to the Career Centre (Central) shall be reported at least forty days before the last date of receipt of the applications of the prospective candidates for purpose of appointment or taking interview or test against the vacancies reported.
(c) The employer shall furnish the information relating to the result of selection to the concerned career centre against the vacancies reported within thirty days from the date of selection.
(9) (a) After commencement of this Code the employers in every establishment in the public sector shall maintain records manually or electronically or digitally about,—
(i) Total number of employees (regular, contractual or fixed term employment) on 31st March of every year;
(ii) Persons recruited during the year ending on 31st March;
(iii) Persons recruited from the sponsored list by carrier centre during the year ending 31st March;

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(iv) Occupational details of its employees on 31st March of every year;
(v) Vacancies for which suitable candidates were not available during the year ending on 31st March; and
(vi) Approximate number of vacancies likely to occur during the next financial year. (b) The Government may, by notification, require that from such date as may be specified in the notification, the employer in every establishment in private sector or every establishment pertaining to any class or category of establishment in private sector shall maintain records manually or electronically or digitally about:—
(ii) Total number of employees (regular, contractual or fixed term employment) on 31st March of every year;
(ii) Persons recruited during the year ending on 31st March;
(iii) Persons recruited from the sponsored list by carrier centre during the year ending 31st March;
(v) Vacancies for which suitable candidates were not available during the year ending on 31st March; and
(vi) Approximate number of vacancies likely to occur during the next financial year. (10)An employer shall furnish to the concerned Career Centre (Regional) yearly return in Form-XXXXII manually or electronically or digitally, as the case may be, within thirty days of the due date, namely, 31st March of the year. (11) Declaration of Executive Officer: (a) The Director of Employment or officer of his equivalent or above rank, controlling the work of Career Centres (Regional) of State, will declare in writing an officer looking after the work of Career Centres (Regional) as “Executive Officer” for each district for the purpose of enforcement/implementation of Chapter XIII (Employment Information and Monitoring) of the Code. He shall be the officer who shall perform duties referred to in Section 139 of the Code, or authorize any person in writing to perform those duties. (8) Levy of penalty under Chapter XIII of the Code: The Director of Employment or an officer of equivalent or above rank, controlling the work of Career Centres of State shall be the competent authority to levy of penalty for an offence under the Code as mentioned in Section 133 for compounding of an offence shall be in Form-XXXXII.

CHAPTER X

Offences and Penalties

(3) The Compounding Officer shall issue a composition certificate in Part IV of Form-XXXXIII within ten days of receipt of the composition amount, to such person from whom such amount has been received in satisfaction of the notice.

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(4) If a person fails to deposit the composition amount within the time, the prosecution shall be instituted before the competent court for the offence in respect of which the compounding notice was issued, against such person.
(5) The court may compound any compoundable offence at any time after filing of a complaint under Section 138 of the Code.

CHAPTER VII

Miscellaneous

Social Security Fund.—(I) Subject to the provisions of sub-section (5) of Section 141 of the code, the other sources of the Social Security Fund for the welfare of the Un-organised Workers may include,—

(c) Any donations from Private Organizations or Bodies.
(d) any other source as may be decided by the Board and as notified by the State Government.
(2) The funds of the Board shall be expended for implementing the various schemes of the Un-organized Workers and such other salaries, allowances and administrative expenses as determined by the Board.
(a) shall maintain such records regarding the exempted employees and submit such returns and other information to the Corporation and the State Government as may be specified in the Regulation; and
(b) in case of change in legal status of an establishment which has been granted exemption under Section 143 of the Code, due to merger, demerger, acquisition, sale, amalgamation, formation into a subsidiary, whether wholly owned or not, etc., the exemption shall be deemed to be cancelled and the establishment shall be required to apply afresh for exemption to the State Government of Goa.

Conditions for management of the trust.— (I) A Board of Trustees shall be established for the management of the Provident Fund or the Pension Fund according to such directions as may be given by the Central Government or the Central Provident Fund Commissioner, as the case may be, from time to time. By order and in the name of the Governor

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

02ND MAY, 2026

FORM-I

[See rule 31(3)] In the Employees' Insurance Court at .................. A.B. (add description and residence) .......Applicant; against C.D. (add description and residence) .........Opposite Party. Other particulars of the application specified in rule 6 Date ... Signature of the applicant

100% (Verification by the applicant) The statement of facts contained in this application is to the best of my knowledge and belief true and correct. Signature Date...

FORM - II

[see rule 32 (4)] List of documents produced by _________________ Applicant Opposite party (Title) e. g. Description, subject, name of the Court, No. | Sr.No. | Description of Document | Date if any, which the document Bear: | Signature of party or pleader or any authorized representative | | --- | --- | --- | --- | | 1 | 2 | 3 | 4 | | | | | |

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FORM III

[see rule 33]

Register of Proceedings

Employee's Insurance Court at... Register of Proceedings in year Q... | Date of presentation of application | No. of proceedings | Applicant | | | Opposite party | | | Claims | | | Appearance | | | Final Order | | | Appeal | | Execution | | | | | Other remarks, if any | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | | | Name | Description | Place of residence | Name | Description | Place of residence | Particulars | Amount of value if any | When the cause of action accrued | Day of parties to appear | Applicant | Opposite party | Date | For whom | For what, or amount | Date of decision of appeal, if any | Judgment in appeal | Date of application | Against whom | For what and amount of money | Amount of costs | Date of order transferring to another civil court of...at... | |

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FORM - IV

(see rule 36) Summons for disposal of proceedings (Title)" To, (Name, description and place of residence). Whereas ... has instituted proceedings against you for ... you are hereby summoned to appear in this Court in person or by authorised agent duly instructed and able to answer: all material questions relating to the case, or who shall be accompanied by some person able to answer ah such questions at ... O'clock in the ... noon on the ... day of ... 20... to answer the claim, and as the day fixed for your appearance is appointed for the final disposal of the proceedings, you must be prepared to produce on that day all the witnesses upon whose evidence and all the documents upon which you intend to relay in support of your defence. Given under my hand and the seal of the Court, this ... day of ... 20 ...

Notice: - 1. Should you apprehend your witnesses will not attend of their own accord, you can have a summons from this Court to compel the attendance of any witness, and the production of any document that you have a right to call on the witness to produce, on the applying to the Court and on depositing the necessary expenses.
1. If you admit the claim. You should pay the money into Court together with the costs of the proceedings to avoid execution of the decree, which, may be against your person or property or both.

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FORM - V

[see rule 42(5)]

Summons for settlement of Issues

Notice:- 1. Should you apprehend your witnesses will not attend of their own accord, you can have a summons from this Court to compel the attendance of any witness and the production of any document that you have a right to call on the witness to produce. on applying to the Court and on depositing the necessary expenses.
1. If you admit the claim. You should pay the money into Court together with the cost of the suit, to avoid execution of the decree which may be against your person or property or both.

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

FORM VI

(The grounds of application should be stated). Date... Signature of the applicant

Verification by the applicant. The statement of facts contained in the application is to the best of my knowledge and belief true and correct. Date Signature Place...

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FORM VII

[see rule 42 (6)]

General Form

(Title) To Whereas the above named... has made application on this Court that... You are hereby warned to appear in this Court in person or by a pleader only instructed at ... O'clock in the ... noon, on the ... day of ... 20 ... to show cause against the application failing wherein, the said application will be heard and determined ex-parte. Given under my hand and seal of the Court, this ...day of... 20 ...

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FORM VIII

[see rule 43 (2)]

Summons to Witness

(Title) To, Whereas your attendance is required to ... on behalf of the... in the above proceedings, you are hereby required (Personally) to appear before this Court on the ... day of ... 20.. at... O'clock in the morning, and to bring with you (or to send to this ... Court .... A sum of Rs. ...being your travelling and other expenses and subsistence allowance for one day, is deposited with this Court and will be tendered to you on the day you appear before the Court. If you fall to comply with this order without lawful excuse, you will be subject to the consequences of non- attendance laid down in rule 12 of Order XVI of the Code of Civil Procedure, 1908 (V of 1908). Given under my hand and seal of the Court, this ... day Of... 20 ... Notice: - If you are summoned only to produce a document and not to give evidence, you shall be deemed to have complied with the summons if you cause such document to be produced in this Court on the day and hour aforesaid. If you are detained beyond the day aforesaid, a sum of Rs... will be tendered to you for each day's attendance beyond the day specified.

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FORM - IX

[see rule 56]

Decree in case

(Title) Claim for This case coming on this day for final disposal beforein the presence of ... for the applicant and of ... for the opposite party, it is ordered and decreed that ... and that the sum of Ra... be paid by the ... to the ... on account of the costs of this suit, with interest thereon at the rate of ... per cent. per annum from this date to the date of realisation. Given under my hand and the seal of the Court, this day of ... 20 ... Court.

Cost of Suit

Rs. a. p.

1. Stamp for application- .... .... ....
1. Stamp for Power- ... ... ...
1. Stamp for exhtbits- .... .... ....
1. Pleader's fee- .... .... ....
1. Subsistence for witnesses-.... .... .... Stamp for Power-.... ....... Pleader’s fee- ......... Subsistence for- ... ... ... witnesses Commissioner's fee- ... ... Total .......

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

Form X

( See Rule 58) | Number of proceedings | Name/s of the party/fees | Date of Decree | Weather any appeal preferred from decree | Payment or adjustment made, if any | Previous application if any, with date and result | Amount with interest due upon the decree or other relief granted thereby together with | Amount of costs, if any awarded | Against whom to be executed | Mode in which the assistance of the court is required | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | | III OF 1949 | A.B- Applicant C.D.- Opposite party | November 11th, 1949 | No | None | Rs. 72-4-0 recorded On application, dated the 9th April, 1949 | Rs. 314-8-2 principal, X (Interest at 6% per annum from date of order till payment | As Awarded in the decree.. Rs. a.p. Subsequently incurred.... Total.. | Against the opposite party C.D | When attachment and sale of movable property is sought.). I pray that the total amount of Rs. ... (together with interest on the principal sum up to date of payment) and the costs of taking out this execution, be realized by attachment and sale of the opposite party's movable property as per annexed list and Paid top me. (When attachment and sale property is sought.) I pray that the total amount of Rs. (together with interest on the principal sum up to date of payment) and the costs of taking out this execution, be realized b y attachment and sale of the opposite party's immova-property specified at the foot of this application and paid to me. | Decree Holder

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Nomination/Fresh Nomination/Modification of Nomination (Strike out the words not applicable) I, Shri Shrimati/Kumari………………………………………(Name in full here) whose particulars are given in the statement below, hereby nominate the persons(s) mentioned below/ have acquired a family within the meaning of clause (33) of section 2 of the Code on Social Security, 2020 (Central Act No.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

2. I hereby certify that the persons(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 (Central Act No.36 of 2020)
1. I hereby declare that I have no family within the meaning of clause (33) of section 2 of the said Code.
(b) My husband’s father/mother/parents is /are not dependent on my husband.
1. 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.
1. Nomination made herein invalidates my previous nomination. Nominee(s) | Sr.No. | Name in full with full address of nominee(s) | Relationship with the employee | Age of nominee | Proportion by which the gratuity will be shared | | --- | --- | --- | --- | --- | | 1. 2. 3. | 1. 2. 3. So on | | | |

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Manner of acquiring a “Family”

(2) Sex
(3) Religion
(4) Whether unmarried/married/widow/widower
(6) Post held with Ticket No. or Serial No., if any
(7) Date of appointment
(8) Permanent address:

02ND MAY, 2026

FORM - XII

(Give here name or description of the establishment will full address) I. …………………………………………(name of employee/nominee/legal heir/nominee of late …………………………………………) (Name of the employee)as a legal heir of late …………………………………………(Name of the employee),beg 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 (Central Act No.36 of 2020) on account of –

(a) My superannuation/retirement/resignation after completion of not less than five years of continuous service/total disability due to accident/total disability 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;
(e) Death of aforesaid employee of your establishment which in service/superannuation on ………………………………………(date) without making any nomination after completion of ………………………………………years of service/total disablement of the said 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 the employee in full, (if, the gratuity is claimed by an employee)
a. Marital status of employee(unmarried/married/widow/widower) Or
(2) Name of nominee/legal heir, (if the gratuity is claimed by nominee/legal heir)
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
(3) Department/Branch/Section where last employed

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(4) Post held by employee.
(10) Total gratuity payable to the employee/share of gratuity claimed by a nominee/legal heir. Place: Date:

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[see rule 68]

(a) as required under clause (b) of sub-rule(1) of rule 22 of the Code on Social Security (Goa) Rules,2026, that your claim for payments of gratuity as indicated on your application in Form-II under the said rules is not admissible for the reasons stated below: Reasons (Here specify the reasons); or
(b) * as required under clause (a) of sub-rule (1) of rule 22 the Code on Social Security (Goa) 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.
1. Amount payable shall be sent to you through demand draft or shall be credited in your bank account as desired by you.
1. Brief statement of calculation
(i) Amount payable :** Place:

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

Application for Direction Before the Competent Authority for Chapter-V under the Code on Social Security, 2020 Date:

2. The applicant submitted an application under Rule …………………… Of the Code on Social Security (Goa) 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.
1. The applicant submits that there is a dispute on the matter (specify the dispute).
1. 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 petitioner and direct the above-mentioned employer to pay the same to the petitioner.
1. The applicant declare that the particulars furnished in the annexure hereto are true to correct to the best of his knowledge and belief. Date: Date: Signature/Thumb impression of the applicant. Signature of the Employer/ Authorized officer Name or description of establishment or rubber stamp thereof.

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ANNEXURE

1. Name in full of applicant with full address
1. Name and address in full of the employee
1. Marital status of the employee(unmarried/married/widow/widower)
1. Name and address in full of the employer
1. Post held by the employee with Ticket or SI. No., if any (if known)
1. Date and cause of termination of service of the employee(Superannuation/retirement/resignation/disability/death/Completionof contract period under Fixed Term Employment)
1. Total period service by the employee
1. Wages last down by the employee
1. If the employee is dead, date and cause thereof
1. Evidence /witness in support of death of the employee
1. If a nominee, No. and date of recording of nomination with the employer Place: Date: Signature/Thumb impression of the applicant

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FORM - XV

[see rule 71] Notice for Appearance before the Competent Authority /Summon Whereas Shri ………………………………………… an employee under you/a nominee(s) /legal heir(s) of Shri …………………………………………an employee under the above –mentioned employer, has/have filed an application under sub-rule(1) of rule 16 of the Code on Social Security (Goa) 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 authorized 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 evidence/you are required to produce the documents mentioned in this 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 and Social Security, 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 with you (or to send to this Authority ) the said documents.

List of documents-

Given under my hand and seal, this ................ day of ..................... 20................

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

[see rule 71(12)]

Notice of Order for payment of Gratuity as Determined by Competent /Appellate Authority

(Strike out the words not applicable) To, (Name and address of employer)

1. Whereas Shri/Smt./Kumari …………………… of 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. before me; or Whereas you/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. 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. Note.— (Strike out paragraphs if not required) Competent Authority Under the Code on Social Security Code, 2020

Note:

1. The portion not applicable to be deleted.
1. The summons shall be issued in duplicate. The duplicate is to be signed and returned by the persons served before the date fixed.

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FORM - XVII

[see rule 71 (14)]

Application for Recovery of Gratuity

Before the Competent Authority under the Social Security Code, 2020 Application No. Date: BETWEEN (Name in full of the applicant with full address) Place: Date: Note—Strike out the words not applicable.

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FORM – XVIII

This is to certify that-

1. *I examined........wife/ daughter of ...... 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. 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............
1. "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.

SERIES I No. 5

FORM – XIX

[see rule 72(2)] (Notice of claim for maternity benefit and payment thereof under sections 62 and 63) To …………………………… (name of establishment)

PART I

[see rule 72(2)(a)] Notice Signature or thumb impression of

PART II

[see rule 72(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 second instalment of maternity benefit after delivery paid on…….

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*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.

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Form XX

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 Date................

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FORM – XXI-A

[see rule 75] 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 The Appellate Authority, Sir, 1.…………, 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). Strike out unnecessary portion. 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

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[se rule 76(5)] (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.
1. 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.
1. (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

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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.
1. (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 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.
1. 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 up to 15 minutes.
1. (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

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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.
1. (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.
1. (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.

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1. (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 1st 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 I have the same meaning as assigned to it in clause (r) of section 2 of the Information Technology Act, 2000 (21 of 2000).

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FORM - XXIII

[see rule 81] (Notice Book of the Accidents) (1) Name of the Establishment ...... (2) Address of the Establishment ... (3) Nature of Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (4) Date of Opening (5) Registration number if any ...... (6) Name of the Employer/Occupier .................. | Serial Number | Date of accident | Short details of accident | Name of the injured person | Whether accident resulted in death | Whether accident resulted in total disablement | Whether accident resulted in partial disablement | Whether accident resulted in temporary disablement | Amount of compensation paid to employee or his dependent | Amount of compensation deposited to Competent Authority | Date of payment or deposit of Compensation | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | (1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) | (10) | (11) | | | | | | | | | | | | |

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FORM – XXIV

[See rule 83] Statement of Fatal Accidents To, Competent Authority, Sir,

1. I have the honor to submit the following statement of an accident which occurred in (date), at (here enter details of premises) and which resulted in the death of the employee/ employees of whom particulars are given in the statement annexed.
1. The circumstances relating to the death of the employee/employees were as under: -
a. Time of accident.
b. Brief History of Accident
c. Place where the accident occurred.
d..Manner in which deceased was/were employed at the time.
e. Cause of the accident.
f. Any Other Relevant Information
1. I am responsible for payment of compensation.
1. Details of employee.
a. Name of the employee ..................................
b. Full postal address
c. Sex ................
d. Age of the employee ..................................................................
e. Wages of the employee ..................................
1. I am not responsible for payment of compensation (Reason) (Signature and designation of person making the statement) Name: Address. Mobile No

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FORM - XXV

[See rule 84] Memorandum of Agreement It is hereby submitted that on the ________________ day of ________________ 20____, personal injury was caused to ________________, residing at ________________, by accident arising out of and in the course of his employment in ________________. The said injury has resulted in permanent disablement to the said workman of the following nature, namely:- The said employee’s monthly wages are estimated at Rs............. The employee is over the age of 15 years/will reach the age of 15 years on ............................................. The said employee has, prior to the date of the agreement, received the following payments, namely:- Rs. ........................................................................ on ........................................................................ Rs. ........................................................................ on ........................................................................ Rs. ........................................................................ on ........................................................................ It is further submitted that the employer of the said employee has agreed to pay, and the said employee has agreed to accept, the sum of Rs. .................................................... in full settlement of all and every claim under the Code on Social Security, 2020 in receipt of the disablement stated above and all disablement now manifest. It is therefore requested that this memorandum be duly recorded. Dated .....................20..................... Signature of employer ................ Witness .................. Signature or employee ................ Witness ………… Note- Application to register an agreement can be presented under signature of one party, provided that the other party has agreed to the terms. But both signatures should be appended, whenever possible. In accordance with the above agreement, I have this day received the sum of Rs.................. Dated .....................20..................... Employee The money has been paid and this receipt signed in my presence. Witness........................................................................ Note- This form may be varied to suit special cases, e.g. injury by occupational disease, agreement when employee is under legal disability, etc.

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FORM - XXVI

[see rule89] Memorandum of Agreement It is hereby submitted that on the _______________ day of ___________ 20______. Personal injury was caused to _______________ residing at _______________ by accident arising out of and in the course of employment in _______________. The said injury has resulted in temporary disablement to the said employee, who is at present in receipt of wages amounting to Rs. _______________ per month/no wages. The said employee's monthly wages prior to the accident are estimated at Rs. _______________. The employee is subject to a legal disability by reason of _______________. Dated .................... 20.... Signature of employer Witness Signature of employee Witness Note- An application to register and agreement can be presented under the signature of one party : provided that the other party has agreed to the terms. But both signatures should be appended, whenever possible. Receipt (to be filled in when the money has actually been paid). In accordance with the above agreement, I have this day received the sum of Rs.................. Dated .....................20 . Employee The money has been paid and this receipt signed in my presence. ................................ Witness Note- This form may be varied to suit special cases, e.g., injury by occupational disease, etc.

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FORM - XXVII

[see rule 84] Memorandum of Agreement It is hereby submitted that on the _______________ day of _______________, 20. personal injury was caused to _______________, residing at _______________, by accident arising out of and in the course of his employment in _______________. The said injury has resulted in death to the said workman. The said employee’s monthly wages are estimated at Rs The employee is over the age of 15 years will reach the age of 15 years on ........................................... . The said employee has, prior to the date of the agreement, received the following payments, namely: -

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This is an eighth second-level heading

This is an eighth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold text

Italic and bold and underlined and code and bold and italic and underlined and code and bold text

Underlined and bold and italic and code and bold and italic and underlined and code and bold text

Code and bold and italic and underlined and code and bold and italic and underlined and code text

This is a ninth second-level heading

This is a ninth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

This is a tenth second-level heading

This is a tenth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

This is an eleventh second-level heading

This is an eleventh third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

This is a twelfth second-level heading

This is a twelfth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

This is a thirteenth second-level heading

This is a thirteenth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

This is a fourteenth second-level heading

This is a fourteenth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

This is a fifteenth second-level heading

This is a fifteenth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

This is a sixteenth second-level heading

This is a sixteenth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

This is a seventeenth second-level heading

This is a seventeenth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

This is an eighteenth second-level heading

This is an eighteenth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

This is a nineteenth second-level heading

This is a nineteenth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

This is a twentieth second-level heading

This is a twentieth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

This is a twenty-first second-level heading

This is a twenty-first third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

This is a twenty-second second-level heading

This is a twenty-second third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

This is a twenty-third second-level heading

This is a twenty-third third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

This is a twenty-fourth second-level heading

This is a twenty-fourth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

This is a twenty-fifth second-level heading

This is a twenty-fifth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

This is a twenty-sixth second-level heading

This is a twenty-sixth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

This is a twenty-seventh second-level heading

This is a twenty-seventh third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

This is a twenty-eighth second-level heading

This is a twenty-eighth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

This is a twenty-ninth second-level heading

This is a twenty-ninth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

This is a thirtieth second-level heading

This is a thirtieth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

This is a thirty-first second-level heading

This is a thirty-first third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

This is a thirty-second second-level heading

This is a thirty-second third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

This is a thirty-third second-level heading

This is a thirty-third third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

This is a thirty-fourth second-level heading

This is a thirty-fourth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

This is a thirty-fifth second-level heading

This is a thirty-fifth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

This is a thirty-sixth second-level heading

This is a thirty-sixth third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold text

Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

This is a thirty-seventh second-level heading

This is a thirty-seventh third-level heading

Bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Italic and bold and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

Underlined and bold and italic and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic text

`Code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold and italic and underlined and code and bold

Rs.……………………………on………………………………Rs.……………………………on………………………………Rs.……………………………on……………………………… It is further submitted that the employer of the said employee has agreed to pay, and dependent (s) of the said employee has agreed to accept, the sum of Rs.………………… in full settlement of all and every claim under the Code on Social Security, 2020 in receipt of death stated above. It is therefore requested that this memorandum be duly recorded. Dated ........................................20........ Signature of employer Witness .................. Witness Signature or dependant(s) Note- Application to register an agreement can be presented under signature of one party; provided that the other party has agreed to the terms. But both signatures should be appended, whenever possible. Receipt (to be filled in when the money has actually been paid) In accordance with the above agreement, I have this day received the sum of Rs..................... Dated .................... 20.... Dependant(s) The money has been paid and this receipt signed in my presence. Witness ..................

198

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

FORM - XXVIII

[see rule 84 (2)] Whereas an agreement to pay compensation is said to have been reached between …………………… and ……………………, whereas …………………… has/have applied for registration of the agreement under Section 89 of the Code of Social Security, 2020, notice is hereby given that said agreement will be taken into consideration on ………… 20………, and that any objections to the registration of the said agreement should be made on that date. In the absence of valid objections it is my intention to proceed to the registration of the agreement. Dated................20............... Competent Authority

FORM - XXIX

[see rule 84 (6)] Take notice that registration of the agreement to pay compensation is said to have been reached between you …………………… And …………………… On the …………………… 20 …………………… has been refused for the following reasons, namely :-

Dated: .................. 0 .................. Competent Authority.

199

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

FORM - XXX

[See rule 84 (6)] Whereas a n agreement to pay compensation is said to have been reached between …………………………… and ………………………… and whereas ………………………… has/have applied for registration of the agreement under 89 of the Code on Social Security 2020 (Central Act 36 of 2020), and whereas it appears to me that the said agreement ought not to be registered for the following reasons, namely:- …… an opportunity will be afforded to your showing of cause on ……………… 20 ………, why the said agreement should be registered. If no adequate cause is shown on that date registration of the agreement will be refused. Competent Authority.

FORM - XXXI

[see rule 84 (8)] Whereas a n agreement to pay compensation is said to have been reached between …………………… and …………………… and whereas …………………… has/have applied for registration of the agreement under 89 of the Code on Social Security 2020 (Central Act 36 of 2020), and whereas it appears to me that the said agreement ought not to be registered for the following reasons, namely:- …… an opportunity will be afforded to your showing of cause on ……………… 20 ………, why the said agreement should be registered. Any representation which you have to make with regard to the said agreement should be made on that date. If adequate cause is then shown, the agreement may be registered. Dated................20................ Competent Authority.

200

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

[see rule 84 (12)] REGISTER FOR AGREEMENT FOR THE YEAR 20................ | Serial number | Date of agreement | Date of Registration | Employer | Employee | Initial of Competent Authority | Reference to order rectifying the register. | | --- | --- | --- | --- | --- | --- | --- | | (1) | (2) | (3) | (4) | (5) | (6) | (7) | | | | | | | | | | | | | | | | |

FORM - XXXIII

[see rule 86 (24)]

NOTICE

Where a claim for compensation has been made by ………… applicant/employer against ………… and the said……… has claimed that you are liable under section 85(2) of the Code on Social Security 2020 (Central Act 36 of 2020), to indemnify him against any compensation which he may be liable to pay in respect of the aforesaid claim, you are hereby informed that you may appear before me on ………… and contest the claim for compensation made by the said applicant or the claim for indemnity made by the opposite party. In default of you appearance you will be deemed to admit the validity of any award made against the opposite party and your liability to indemnify the opposite party for any compensation recovered from him. Dated................20...... Competent Authority

201

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

FORM – XXXIV

[See rule 86 (24)]

NOTICE

Whereas a claim for compensation has been made by ……………… applicant, against ……………… and the said ……………… has claimed that ……………… is liable under section 85(2) of the Code on Social Security, 2020 (Central Act 36 of 2020), to indemnify him against any compensation which he may be liable to pay in respect of the aforesaid claim, and whereas the said ……………… on notice served has claimed that you ……………… Stand to him in the relation of a contractor form whom the applicant ……………… could have recovered compensation. You are hereby informed that you may appear before me on ……………… on contest the claim for compensation made by the said applicant or the claim for indemnity made by the opposite party ……………… In default of your appearance you will be deemed to admit the validity of any award made against the opposite party ……………… And your liability to indemnify the opposite party ……………… For any compensation recovered from him. Dated ................ 20................ Competent Authority.

202

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

FORM - XXXV

[See rule 86(31)] 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):

203

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

FORM - XXXVI

[see rule 86(31)]

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
1. Name of the employer and address details
1. Name and address or location of place where the building or other construction work is proposed to be carried on.
1. Name, designation and address of the authorised Person along with contact details
1. Correspondence address for the proposed building or other construction work
1. Nature of proposed construction work
1. Date of commencement of work (in case construction has started)
1. Approximate duration of work
1. Total proposed area of construction work
1. 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) alongwith documents (original).
1. Total estimated cost of construction as certified by chartered engineer
12 Amount of provisional cess %age of total estimated cost of the construction as notified by the Government Total estimated cess (in Rs.)
1. Advance cess paid, alongwith details (at the time of approval of the Project or before the commencement of the construction work) or deduction at source.
1. Details of cess paid (when duration of the proposed construction work is more than one year)
1st Year ....... Amount in Rs.
2nd Year .......Amount in Rs.
3rd Year .......Amount in Rs.
1. Total Amount of Cess Paid (13+14)

204

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SERIES I No. 5

02ND MAY, 2026

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.
1. 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.

205

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

FORM - XXXVII

[See rule 86 (31)]

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 MMYYYY | | | 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 other applicable rates) along with supporting documents (original) as per Rule 42 | | | | | 8 | Total Incurred Cost of the Construction Work | | | | | 9 | Total Amount of Cess Payable | | % of total incurred cost of the construction as notified by the Central Government: | Total Cess Payable (in 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 | | | | | 11.1 | 1st Year | | | | | 11.2 | 2nd Year | | | | | 11.3 | 3rd Year | | | | 12 | Total amount of cess paid (Sr. No. 10 + Sr. No. 11) | | | | | 13 | Amount of outstanding cess (Sr. No. 9-Sr. 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 | | | |

206

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

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.
1. 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.

207

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

FORM- XXXVIII

[see rules 86 (31)]

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 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 42 | | | | | 12 | Total incurred cost of the construction work | | | | | 13 | Total amount of cess payable | | % of total incurred cost of the construction as notified by the Central Government | Total cess payable (in 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 proposed construction work is more than one year) | | | | | | Sl. No. | Year | Amounts (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 | | | |

208

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

| 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 misrepresented in the above calculation made by me/us.
2.1/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.

209

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

FORM-XXXIX

[See Rule 91]

REGISTER OF WOMEN EMPLOYEES

Name and address of establishment

1. Registration Number if any of the establishment
1. Name of woman and her father's (or, if married, husband's) name
1. Date of appointment.
1. Nature of work.
1. 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 | Remark | | --- | --- | --- | --- | --- | | A | B | C | D | D | | | | | | |
1. Date on which the woman gives notice under section 62.
1. Date of discharge/dismissal, if any.
1. Date of production of proof of pregnancy under section 62.
1. Date of birth of child.
1. Date of production of proof of delivery/miscarriage/Medical Termination of pregnancy/tubectomy operation/death/adoption of child
1. Date of production of proof of illness referred to in section 65.
1. Date with the amount of maternity benefit paid in advance of expected delivery.
1. Date with the amount of subsequent payment of maternity benefit.
1. Date with the amount of bonus, if paid, under section 64.
1. Date with the amount of wages paid on account of leave under section 65(1) & 65(3).
1. Date with the amount of wages paid on account of leave under section 65(2)and period of leave granted.
1. Name of the person nominated by the woman under section 62.
1. 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.
1. 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.
1. Signature of the employer of the establishment authenticating the entries in the register of women employees.
1. Remarks column for the use of the Inspector-cum-Facilitator.

210

OFFICIAL GAZETTE — GOVT. OF GOA (SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

FORM-XXXX

[see rule 91]

Unified Annual Return

A. General Part:
(a) Name of the establishment ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................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Address of the establishment : House No./Flat No.………………………………………Street No/Plot No.………………………………………

•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
Town.....................District.....................State.....................Pin code.....................
- (b)Name of the employer ..................................................
House No./Flat No.……………………………………………………………Street No. /Plot No.…………………………………………………………
Town.....................District.....................State.....................Pin code.....................
Email ID........................................................................Telephone Number........................................................................Mobile No........................................................................
- (c) Name of the manager or person responsible for supervision and control of establishment
.
Address:
Town.....................District.....................State.....................Pin code.....................
Email ID...........................................................................Telephone Number...........................................................................Mobile No...........................................................................
- B. Employer’s Registration /Licence number under the Codes mentioned in column (2) of the table below:
| Sr. No. | Name | Registration | If yes   (Registration No.) |
| --- | --- | --- | --- |
| (1) | (2) | (3) | (4) |
| 01. | The Code on Occupational Safety Health and working condition code 2020. |  |  |
| 02. | The Code on Social Security 2020. |  |  |
| 03. | Any other law for the time being in force. |  |  |

## C. Details of Employer, Contractor and Contract Labour:
| 01. | Name of the employer in the case of a contractor's establishment. |  |
| --- | --- | --- |
| 02. | Date of commencement of the establishment. |  |

211

OFFICIAL GAZETTE — GOVT. OF GOA
(SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

## FORM-XXXXI
[see rule 93]

## FORM FOR REPORTINGVACANCIES 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 & Type of Establishment
(Central Government, State Government, PSU,
Autonomous, Private, etc)
Registration No of establishment under 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 and the number of
the vacancy(ies) to be filled
(b) Description of duties of
the post (job
role/functional role)
- (c)Qualifications/Skills required
(educational, technical,
experience)
- (i) Educational Qualifications
- (ii) Technical Qualifications
- (iii) Skills
- (iv) Experience
- (d) Age Limits, if any
(Age as on last date of application)
- (e)Preferences(such as Ex-servicemen, Persons
With Disabilities, women, etc)if any
- (e) Duration of employment
(i) 3-6 months
(ii) 6-12months
(iii) 12monthsand more Number of posts
- 4. Whether there is any obligation for arrangement for giving reservation/ preference to
any category of persons such as Scheduled Caste(SC), Scheduled Tribe(ST),
Economically Weaker Sections(EWS),Other Backward Classes(OBC), Ex-serviceman and
Persons With Disabilities (PWD) , etc, in filling up the Vacancies : Yes/No
- 5. (if yes, give the number of vacancies to be filled by such categories of persons as detailed
below)

212

OFFICIAL GAZETTE — GOVT. OF GOA
(SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

| 03. | Number of Contractors engaged in the establishment during the year. |  |
| --- | --- | --- |
| 04. | Total Number of days during the year on which Contract Labour was employed. |  |
| 05. | Total number of man-days worked by Contract Labour during the year. |  |
| 06. | Name of the Manager or Agent (in case of mines). |  |
| 07. | Address House No/Flat No...................................... Street/Plot No. Town District   ......................................State................................................................PinCode.......   E-mail ID...............Telephone Number ........................Mobile Number   ...................................... | |

## D. Working hours and weekly rest day:
| 01. | Number of days worked during the year. |  |
| --- | --- | --- |
| 02. | Number of mandays worked during the year |  |
| 03. | Daily hours of work. |  |
| 04. | ....................Weekly day of rest |  |

## E. Maximum number of persons employed in any day during the year:
| Sr. No. | Males | Females | Adolescents (between the age of 14 to 18 years) | Children (below 14 years of age) | Total |
| --- | --- | --- | --- | --- | --- |
|  |  |  |  |  |  |

## F. Wage rates (Category Wise):
| Category | Rates   of   wages | No. of workers | | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
|  |  | Regular | | | | Contract | | | |
|  |  | Male | Female | Children | Adolescent | Male | Female | Children | Adolescent |
| Highly   Skilled |  |  |  |  |  |  |  |  |  |
| Skilled |  |  |  |  |  |  |  |  |  |
| Semiskilled |  |  |  |  |  |  |  |  |  |
| Unskilled |  |  |  |  |  |  |  |  |  |
| Clerical |  |  |  |  |  |  |  |  |  |

## G. (a) Details of Payments:
| Gross wages paid | | Deductions | | | Net wages paid | |
| --- | --- | --- | --- | --- | --- | --- |
| In cash | In kind | Fines | Deductions for damage or loss | Others | In cash | In kind |
|  | |  | | |  | |
|  | |  | | |  | |

213

OFFICIAL GAZETTE — GOVT. OF GOA
(SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

- (b) Number of workers who were granted leave with wages during the year:
| Sr. No. | During the year | Number of workers | Granted leave with wages |
| --- | --- | --- | --- |
- H. Details of various welfare amenities provided under the statutory schemes:
| Sr.   No. | Nature of various welfare amenities provided | Statutory   (specify the statute) |
| --- | --- | --- |
|  |  |  |
- I. Maternity Benefit under the Code on Social Security, 2020:
- (a) Details of establishment, medical and para-medical staff:
| 01. | Date of opening of establishment |  |
| --- | --- | --- |
| 02. | Date of closing, if closed |  |
| 03. | Name of Medical Officer |  |
| 03(i) | Qualification of Medical Officer |  |
| 03(ii) | Is Medical Officer at ( the mines or circus)? |  |
| 03(iii) | If a part time, how often does he/she pay visit to establishment |  |
| 03(iv) | Is there any Hospital? |  |
| 03(v) | If so, how many beds are provided ? |  |
| 03(vi) | Is there a lady Doctor? |  |
| 03(vii) | If so, what is her qualification ? |  |
| 03(viii) | Is there a qualified mid-wife? |  |
| 03(ix) | Has any crèche been provided |  |
- (b) Leave Granted under the Code on Social Security, 2020
| 01. | Total number of female employees in the establishment |  |
| --- | --- | --- |
| 02. | Total number days of leave granted |  |
| 03. | Number of employees granted maternity leave/benefited by ESI |  |

## Declaration
It is to certify that the above information is true and correct and also I certify that I have complied with all the provisions of Labour Laws applicable to my establishment.
Dated:
Place:
Sign.Here

214

OFFICIAL GAZETTE — GOVT. OF GOA
(SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

|  | Category | Number of vacancies to b filled | |
| --- | --- | --- | --- |
|  | (a) Scheduled Caste     (b) Scheduled Tribe     (c) OBC     (d) EWS     (e) Ex-Serviceman     (f) Persons With Disabilities(PWD)     (g) Women     (h) Others(specify) |  | *By Priority candidates     *(Applicable for     Central     Government     vacancies) |
| 6. | 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     details, if any. |  | |
| 7. | Place of work( Name of the     town/village and district, Pin Code     ,etc. in which it is situated) |  | |
| 8. | Mode of Application (email, online, in     writing, etc) and Last date for receipt of     applications. |  | |
| 9. | Particulars of officer to whom the     applications be sent/candidates     should approach(Mention     Name, designation, email id, address,     Telephone No., website address in case     of online) |  | |
| 10. | Mode of Recruitment     {Through Career Centre, Placement     Agency, self-management, any other     mode(specify) } |  | |
| 11. | Would like to prefer submission of list     of eligible candidates registered with     Career Centre | Yes/No | |
| 12. | Any other relevant information |  | |
Signature, Name &Designation of Authorised
Signatory of establishment/ employer with
seal & 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) |  |
Signature
Name & Designation of Authorized
Signatory of Career Centre with seal
& date
NOTE
:

215

OFFICIAL GAZETTE — GOVT. OF GOA
(SUPPLEMENT No. 2)

SERIES I No. 5

02ND MAY, 2026

- 1. Career Centre to which the vacancies are reported, would provide a unique vacancy reporting number for the vacancy reported and convey it to the employer in writing, through email or digitally or through any other such media immediately but in any case not later than 3 working day from the date of receipt of reporting of vacancies.
- 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 be reported in writing or through valid official email or digitally (including through a portal) as the case may be, to the appropriate Career Centre.

## FORM-XXXXII
[see rule 93 (10)]

## FORM for EIR (EMPLOYMENT INFORMATION RETURN)
Yearly Return to be submitted to the Career Centre (Regional) for the Year ended ... ... ... ... ...
The following information is required to be submitted under the Code on Social
Security (Chapter II - Employment Information &Monitoring) 2020.
| Name & Address of the Employer |  | |
| --- | --- | --- |
| Whether-Head Office |  | |
| Branch Office   Type of Establishment   (Public/Private Sector) |  | |
| Nature of business/Principal activity |  | |
| Establishment Registration No. under the Code |  | |
| 1.(a)EMPLOYMENT   *Total number of manpower of establishment including working proprietors/partners//contingent employes* 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 previous Year | On the last working day of the Year underreport |
| MEN   WOMEN   Other (Transgender)   TOTAL :   PWD (Persons   With Disabilities)   out of above total |  |  |
(EIR-continued)
*2. Number of vacancies* occurred and reported to Career Centre during the year and the number of Vacancies filled during the year*

| Occurred | Reported | | Fille   d | Source(Career   Centre/ NCS   Portal/   Govt. Recruiting   Agencies/ Private   Placement   Organizations/oth   ers) |
| --- | --- | --- | --- | --- |
|  | Career   Centre   (Regional) | Career   Centre   (Central) |  |  |

216

02ND MAY, 2026

| 1 | 2 | 3 | 4 | 5 |
| --- | --- | --- | --- | --- |
|  |  |  |  |  |
*AsperprovisionsofCodeonSocialSecurity2020(ChapterI I)andRulesmadethere under ,
- 3. MANPOWERSHORTAGES:Vacancies/postsremainedunfilledbecauseofshortageofsuitableapplicants.
| Name of the occupation or Designation o the post | Number of unfilled vacancies/posts | | |
| --- | --- | --- | --- |
|  | Skill/qualifications (educational/technical/ experience) prescribed | Essent | Desirab |
| 1 | 2 | 3 | 4 |
|  |  |  |  |
(Please list any other occupations also for which t his establishment had any difficulty in obtaining suitable applicants recently
- 4. Estimated Manpower Requirement by Occupational Classification during the next calendar 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   youarelikelytofillduringthenextfinancialyearduetoretirement/expansi   on   orre-organization. | | | | |
| --- | --- | --- | --- | --- | --- |
| Description | Me   n | Wome   n | Others   (transgender) | Tota   1 | PWD   (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 EntrOperator ....................................................so on.]
Signature, Name & Designation of
Authorized Signatory of establishment/

217

OFFICIAL GAZETTE — GOVT. OF GOA
(SUPPLEMENT No. 2)

02ND MAY, 2026

employer with seal & date
- Note :1. This return is to be rendered to the Career Centre (Regional) within 30 day after the end of the financial year concerned by establishments/employers vide their obligation under the Code on Social Security 2020 (Chapter II-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 job seekers 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.

218

OFFICIAL GAZETTE — GOVT. OF GOA
(SUPPLEMENT No. 2)

02ND MAY, 2026

## FORM - XXXXIII
[see rule 94 ]
Notice to the Employer who committed an offence for the first time for compounding of offence under
sub-section (1) of section 138 of the Code on Social Security, 2020
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 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/Rule/Regulations under which the offence is committed. |  |
| 6. | Compounding amount required to be paid towards composition of the offence. |  |
| 7. | Name and details |  |

## PART II
In view of the above, you have an option to pay the above mentioned amount 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 of the Compounding Officer)
Place :

## PART III
[See Rule 49 (2)]
Application under sub-section (4) of section 138 of the compounding of offence
Ref: Notice No. ........................................
Date:
- 1. Details of the compounding amount deposited (copy of electronically or otherwise generated receipt to be attached :
- 2. Details of the prosecution, if filed for the violation of above-mentioned offences may be given:
- 3. 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 :
Dated:
Signature of the applicant
Place:
To,
…………………… (compounding officer)
…………………… (name of the officer)
…………………… (address)

## PART VI
Composition Certificate
[See Rule 49 (3)]
Ref : Notice No.…………………………
Date :
This is to certify that the offence under sub-section ......... of section 133 of the Code in respect of which Notice No........... dated ...... was issued to Shri ............ (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 offence to the satisfaction of the said Notice.
(Signature)
Name and Designation of the Officer.
Date :
Place:
To,
…………………… (Employer/Establishment)
…………………… (Name and Registration number)
…………………… (Address).
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220

Draft Code on Social Security (Goa) Rules

Full rule text

SUPPLEMENT

DRAFT RULES

CHAPTER I

CHAPTER II

Social SecurityOrganisations

CHAPTER III

Employes Insurance Court

CHAPTER IV

Gratuity

CHAPTER V

MaternityBenefity

CHAPTER VI

Employees Compensation

Maintenance of Records, Registers, Returns, etc.

CHAPTER VIII

Employment Exchange

CHAPTER X

Offences and Penalties

CHAPTER VII

Miscellaneous

FORM-I

FORM - II

FORM III

Register of Proceedings

FORM - IV

FORM - V

Summons for settlement of Issues

FORM VI

FORM VII

General Form

FORM VIII

Summons to Witness

FORM - IX

Decree in case

Cost of Suit

Form X

Manner of acquiring a “Family”

FORM - XII

ANNEXURE

FORM - XV

List of documents-

Notice of Order for payment of Gratuity as Determined by Competent /Appellate Authority

Note:

FORM - XVII

Application for Recovery of Gratuity

FORM – XVIII

FORM – XIX

PART I

PART II

Form XX

Appeal under Section 68

FORM – XXI-A

FORM - XXIII

FORM – XXIV

FORM - XXV

FORM - XXVI

FORM - XXVII

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