Form XXVII

[See rule 182(1)]

Notice to the employer for an offence committed under the provisions of the Code for the first time for composition of offences

Notice No…………… Date:

On the basis of records and documents produced before me, the undersigned has reasons to believe that you, being the employer of the establishment……………..

(Registration No………….), have committed an offence for the violation of provision of the Code or the Schemes or the Rules or the Regulations or the Standards

framed thereunder as per the details given below:-

PART – I

1. Name of the person:

2. Name and Address of the establishment :

3. Registration No. of the establishment:

4. Particulars of the offence:

5. Provisions of the Code/Scheme/Rules/Regulations under which the offence is committed:

6. Amount required to be paid for compounding of the offence:

7. Name and details of account for depositing the amount specified in serial no. 6:

PART –II

In view of the above, you have an option to pay the entire amount mentioned at serial no. 6 in Part-I within fifteen days from the date of issue of this notice and return the

application duly filled in Part – III of this notice.

In case the said amount is not paid within the specified time, necessary action for institution of prosecution shall be initiated without giving any further opportunity in this

regard.

(Signature)

(Name and designation of Officer)

Date:

Place:

To:

………………..(Employer/Establishment)

…………………(Name and registration number)

………………….(Address)

PART – III

[See rule 182(2)]

Application under section 114 for composition of offence

Ref: Notice No………….. Date:

The undersigned has deposited the entire amount as specified at serial 6 of Part-I and the details of payment are given below with a request to compound the offences mentioned in

Part-I.

8. Details of the compounding amount deposited (Copy of the electronically generated receipt to be attached):

9. Details of the prosecution, if any filed in respect of the violation of the above-mentioned offences:

10. Whether the present offence is a first offence or whether the applicant has committed any other offence prior to this offence, if so, then, full details of such offence:

11. Any other information which the applicant desires to provide:

Signature of the applicant

(Name and Designation)

Date:

Place:

To:

………………..(Compounding Officer)

…………………(Name of the Office)

………………….(Address)

PART – IV

[See rule 182(3)]

Composition Certificate

Ref: Notice No………….. Date:

This is to certify that the offence under sub-section ….. of section 114 in respect of which Notice No. Dated: _____ was issued to Sh/Smt. ………….

(Applicant), the employer of ……………. (name and registration number of the establishment) has been compounded on upon receipt of thefull amount of

dRs ……….. (Rupees _________________) towards compounding of the offence, to the satisfaction of the requirements of the said notice.

(Signature)

Name and Designation of the Officer

Date:

Place:

To:

………………..(Employer/Establishment)

…………………(Name and registration number)

………………….(Address)