The Occupational Safety, Health and Working Conditions (Lakshadweep) Rules, 2025
Form 45
Official text
Open in the official PDF (p. 267)
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(See rule 146)
Performa for Appeal before the Appellate
Authority against Order of Imposing Penalty
To
Appellate Authority
(Under Section 111(2) of the Code)
Sir,
I undersigned with following details prefer an appeal against order of ………………..
(details of officer imposing penalty) under section 111(2) of the Occupational Safety, Health
and Working Conditions Code 2020.
1. Name and address of the establishment.
2. Name of the person preferring appeal and address details
3. Amount of penalty imposed by the officer.
4. Ground for Appeal with supporting documents Declaration
I/We hear by declare that the particulars given above are true to the best of my/our
knowledge and belief and I/We hereby declare that nothing has been concealed on any fact has
been mis-represented in the above calculation made by me/us.
Signature of person preferring appeal
Name :
Date :
Place :
Mobile Number :
E-mail (If any)