Form XXXIV

Made under The Occupational Safety, Health and Working Conditions Code, 2020No. B-11011/12/2026-LESDE, 12 Aug 2026

Official text

Open in the official PDF (p. 241)

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[See rule 150(1)]

APPLICATION UNDER SUB-SECTION (4) OF SECTION 56

FOR COMPOUNDING OF OFFENCE

1. Name of applicant:……………………………………………………..

2. Father’s / Husband’s name of the applicant…………………………………………………….….

3. Address of the applicant ……………………………………………………….

4. Mobile number/email

5. Name, address, Mobile no, and email of Complainant

6. Whether any case pending before any authority or Court in the same matter

7. If Yes, Particulars .......................................................

8. Particulars of the offence………………………………………………

9. Section of the Code under which the offence is committed…………………………..

1.--------------------- 3.--------------------

2.---------------------- 4.--------------------

10. Maximum fine provided for the offence under the Code……………………………….

11. 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……………………………

…………………………………………………………………………………………

………………………………………………………………………..

12. Any other information which the applicant desires to provide

…………………………………………………………………………………………

……………………………………………..

Dated:

Applicant (Name and signature)

Source: The Mizoram Occupational Safety, Health and Working Conditions Rules, 2026, No. B-11011/12/2026-LESDE — Mizoram Gazette Extraordinary, Vol. LV, Issue No. 674, 13 August 2026, p. 241 of the PDF. Open our copy at p. 241 · official download · all sources