Form XXXI (A)

[See Rule 69(3)(b)]

Whereas an agreement to pay compensation is said to have been reached between . . . . . . . . . . . . .

and . . . . . . . . . . . and whereas . . . . . . . . . . . . . . . .has /have applied for registration of the agreement under

section 89 of the Code on Social Security, 2020 and whereas it appears to me that the said agreement ought

not to be registered for following reasons, namely:-

1.

2.

__________ an opportunity will be afforded to you of showing cause on . . . . . . . . . 20 . . . . . . . . by the

said agreement should be registered. If no adequate cause as shown on that date, registration of the agreement

will be refused.

Competent Authority