The Occupational Safety, Health and Working Conditions (Lakshadweep) Rules, 2025
Form 46
Official text
Open in the official PDF (p. 268)
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[See rule 147 (2)]
APPLICATION UNDER SUB-SECTION (1) OF SECTION 114 FOR COMPOSITION
OF OFFICE
To
The authorized officer
[under section 114 (1)]
1. Name of applicant :
…………………………………………………………………………
2. Father’s / Husband’s name of the applicant ………………………………….
3. Address of the applicant …………………………………….
4. Name and address of establishment in relation to applicant
……………………………
5. Particulars of the offence …………………………………………
6. Section of the Code under which the offence is committed ………………………….
7. mazimum fine provided for the offence under the Code …………………………..
8. Whether prosecution against the applicant is pending or
not………………………………….
9. Whether the offence is first offence or the applicant had committed any other offence
prior to the offence, if had committed, then full detail of the offence.
…………………………………………………………………………………………
……………………………………………………
…………………………………………………………………………………………
……………………………………………………
10. Any other information which the applicant desires to provide
…………………………………………………………………………………………
…………………………………………………….
…………………………………………………………………………………………
…………………………………………………….
Applicant
(Name and signature)
Dated