Form XXIX

[See rule 58(1)]

Whereas a claim for compensation has been made by .................. (applicant) against.................and the

said applicant has claimed that he is entitled to file an application under clause (b) or (c) of sub-

section (1) of section 92 of the Chapter VII under the Code on Social Security, 2020;

And whereas the undersigned is satisfied that the said applicant is entitled to file the aforesaid claim;

Now, therefore, the competent authority for Employees Compensation.........................../Government

of........................ is hereby given notice that the undersigned proposes to settle the claim of the

applicant as provided under the Code.

Dated: Competent authority