Form 53

Made under The Occupational Safety, Health and Working Conditions Code, 2020Notification No. 962/XXXVI-03-2026-1903305, 27 Aug 2026

Official text

Open in the official PDF (p. 538)

Tables and forms lose their layout when extracted; the PDF is the authoritative version.

[See rule 171 (1)]

APPLICATION FOR COMPOSITION OF OFFENCE

1. Name of applicant

2. Father’s / Spouse name

3. Address of the applicant

4. Name of establishment: : : :

5. Particulars of the offence:….. ..…………………………………………………………………………

…………………………………………………………………………………………………………………

…………………………………………………

…………………………………………………………………………………………………………………

…………………………………….

6. Section of the Code under which the offence is committed

:……………………………………………………………..

7. Maximum fine provided for the offence under the Code

:………………………………………………………………….

8. Whether prosecution against the applicant is pending or not

……………………………………………………..

9. Whether the offence is a first offence or whether the applicant has committed any other offence prior to

the offence. If yes, then, full details of such prior offence

…………………………………………………………………………………………………………………

…………………………………………………

…………………………………………………………………………………………………………………

……………………………………..

10. Any other information which the applicant desires to provide

…………………………………………………………………………………………………………………

…………………………………………………

…………………………………………………………………………………………………………………

……………………………………..

Dated:

Applicant

(Name and signature)

Source: The Uttar Pradesh Occupational Safety, Health and Working Conditions Rules, 2026, Notification No. 962/XXXVI-03-2026-1903305 — Uttar Pradesh Gazette Extraordinary, 27 August 2026, p. 538 of the PDF. Open our copy at p. 538 · official download · all sources

The rules were made in Hindi. The English text is the translation published by order of the Governor under clause (3) of Article 348 of the Constitution, which makes it the authoritative text in English. Rule headings are printed as marginal notes.