Form XIV

[See Sub-Rule (1) (2) (3) of Rule 29]

Notice to the Employer who committed an offence for the first time for

compounding of offence under subsection (1) of section 138 of the Code on

Social Security, 2020

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 offence for the violation of provision of

the Code or the Schemes or the Rules or the Regulations framed there under 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. Compounding amount required to be paid towards

composition of the offence:

7. Name and Details of Account for depositing the Amount

specified in Column 6:

PART –II

In view of the above, you have an option to pay the above-mentioned amount

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 filing of prosecution shall be initiated

without giving any further opportunity in this regard.

(Signature of the Compounding Officer)

Date:

Place:

PART – III

[See Rule (2) of Rule 29]

Application under sub-section (4) of section 138 for compounding of offence

Ref: Notice No…………..

Date:

The undersigned has deposited the entire amount as specified in Column 6 of

Part-I and the details of payment are given below with a request to compound the

offences mentioned in Part-I.

1. Details of the compounding amount deposited (Copy of electronically generated

receipt to be attached):

2. Details of the prosecution, if filed for the violation of above-mentioned offences

may be given:

3. Whether the offence is first offence or the applicant had committed any other

offence prior to this offence, if committed, then, full details of the offence:

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

Signature of the applicant

(Name and Designation)

Dated:

Place:

PART – IV

Composition Certificate

[See Sub- Rule (3) of Rule 29]

Ref: Notice No………….

Date:

This is to certify that the offence under sub-section ……… of section 133 of the

Code in respect of which Notice No. Dated: _____ was issued to

Sri…………. (Applicant), the employer of ……………. (name and Registration

Number of establishment) has been compounded on account of remission of full

amount of Rs ………. (Rupees_________________) towards the composition of

offences to the satisfaction of the said Notice.

(Signature)

Name and Designation of the Officer

Date:

Place: