Form XXVI — Application for Composition of Offence

Rule: Rule 182(1) · Signed by: Occupier · Under: OSH & Working Conditions (Central) Rules 2026

What the form records

• Name of applicant
• Father's / Spouse name
• Address of the applicant
• Name of establishment
• Particulars of the offence
• Section of the Code under which the offence is committed
• Maximum fine provided for the offence under the Code
• Whether prosecution against the applicant is pending or not
• 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
• Any other information which the applicant desires to provide
• Applicant (Name and signature)
• Dated

This page opens the blank statutory form in MedFactory, ready to fill, save and print. See the Form XXVI reference page for the rule and signatory detail.

MedFactory — Occupational Health Centre software for Indian factories