The Occupational Safety, Health and Working Conditions (Andhra Pradesh) Rules, 2026
Form XII(D)
Official text
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PART – III
[See rule 141(3)]
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:
Date:
Place:
Signature of the applicant
(Name and Designation)
To:
………………..(Compounding Officer)
…………………(Name of the Office)
………………….(Address)