FORM D

(See Rule 6)

Notice of Change

1. Name of the establishment and/or name of occupier/employer ………………………………………

2. Full Address …………………………………………………………………………………………………

3. Registration Certificate No. ………………. Dated the ………………. Date of ……………. 19 …….

The Chief Inspector under the Delhi Shops & Establishments Act, 1954

Notice is hereby given that the following change has taken place in respect of information relating to
Part I of the Form A which please note.

Signature of the occupier/employer

Note – Notice of change in this form shall be sent together with such fees as are prescribed in
Schedule II.