Form XXVI

Made under The Occupational Safety, Health and Working Conditions Code, 2020G.S.R. 345(E), 8 May 2026

Official text

Open in the official PDF (p. 315)

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[See rule 182(1)]

APPLICATION FOR COMPOSITION OF OFFENCE

1. Name of applicant :

2. Father’s / Spouse name :

3. Address of the applicant :

4. Name of establishment:

5. Particulars of the offence:….. ..…………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………….

6. Section of the Code under which the offence is committed :……………………………………………………………..

7. Maximum fine provided for the offence under the Code :………………………………………………………………….

8. Whether prosecution against the applicant is pending or not ……………………………………………………..

9. Whether the offence is a first offence or whether the applicant has committed any other offence prior to the offence. If yes, then, full details of such prior

offence

……………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………..

10. Any other information which the applicant desires to provide

……………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………..

Applicant

(Name and signature)

Dated:

Source: The Occupational Safety, Health and Working Conditions (Central) Rules, 2026, G.S.R. 345(E) — Gazette of India, p. 315 of the PDF. Open our copy at p. 315 · official download · all sources