Form XXXV

[See Rule 80]

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

offence under sub-section (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 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. 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.

Date : (Signature of the Compounding Officer)

Place :

PART – III

[See Rule 80 (2)]

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:

Dated :

Signature of the applicant

(Name and Designation)

PART – IV

[See Rule 80 (3)]

Composition Certificate

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 Sh…………….……. (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.

Date : (Signature)

Place : Name and Designation of the Officer