Form XXVII — Notice to employer for composition of a first offence

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

What the form records

• Notice No.
• Date
• Name of the establishment (of which you are employer)
• Registration No.
• Name of the person
• Name and Address of the establishment
• Registration No. of the establishment
• Particulars of the offence
• Provisions of the Code/Scheme/Rules/Regulations under which the offence is committed
• Amount required to be paid for compounding of the offence
• Name and details of account for depositing the amount specified in serial no. 6
• Part-II Name and designation of Officer
• Part-II Date
• Part-II Place
• Part-III Ref: Notice No.
• Details of the compounding amount deposited (Copy of the electronically generated receipt to be attached)
• Details of the prosecution, if any filed in respect of the violation of the above-mentioned offences
• Whether the present offence is a first offence or whether the applicant has committed any other offence prior to this offence, if so, then, full details of such offence
• Any other information which the applicant desires to provide
• Signature of the applicant (Name and Designation)
• Part-IV Ref: Notice No.
• Offence under sub-section of section 114
• Applicant (Sh/Smt) name
• Name and registration number of the establishment
• Amount compounded dRs (Rupees)
• Part-IV Name and Designation of the Officer

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

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