Form X

[See Sub-rule (1) Rule 50]

PART-A

APPLICATION OF EMPLOYER FOR COMPOUNDING THE OFFENCES UNDER

SUB-SECTION (1) OF SECTION 56 OF THE CODE

To,

The Compounding Officer,

Office of the Additional/ Deputy Labour Commissioner,

Region ……………………

Date: …………………..

Dear Sir/ Madam,

I/We ……………………………… , son of/ wife of/ husband of …………………………

employer of M/s ……………………. address ………………… am/ are desirous of making composition of

offence under sub-section (1) of Section 56 of the Code on Wages, 2019. I/We have/had committed

following offence(s) under the Code:

1. …………………………………………………….

2. …………………………………………………….

3. …………………………………………………….

Prosecution for the above violations-

1. * has not been filed in any competent Court against the undersigned.

2. * has been filed against the undersigned in the Court of ……………….

The details of the prosecution filed are given below:

1. Date of Inspection/ complaint: …………………..

2. Case no. and date of filing of prosecution: ……………………..

3. Section(s) and Rule(s) which were found violated: ………………………..

4. Name and designation of the person who has filed the prosecution: ……………………

5. Whether prosecution against the applicant is pending or not: ………………………

6. Whether the offence is first offence, or the applicant has committed any other offence prior to this

offence? If yes, then full details of the prior offence:

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

……………………………………………………………………………

7. Any other information which the applicant desires to provide:

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

…………………………………….………………………………………

It is therefore requested that kindly give me direction or allow me to deposit the compounding

amount as per sub-section (1) of the Section 56 of the Code on Wages, 2019. It is also requested to the

Compounding Officer to inform the competent Court under section 52 and /or Officer authorized

under section 53 for imposing penalty.

Date: Name and signature of applicant

Place: Name of the establishment:……………

Address of Establishment:…………………

* strike out whichever is not applicable

PART-B

COMPOSITION CERTIFICATE

Reference Notice number: ……………………….. Date: ………………………

This is to certify that the offence under sub-section …………………. of Section 54 in respect of

which notice number ………………………… dated …………………. was issued to

……………………………………(applicant), the employer of ………………………………….(name and

registration number of the 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.

(Signature)

Name and Designation of the Compounding Officer

Date:

Place:

To,

……………………………….(employer/ establishment)

……………………………… (name and registration number)

………………………………(address)

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