📄 Template provided by Embar Legal Advocates, Mysore — PoSH Advisory · shebox.in
Submit to the District Officer by 31 January each year for the preceding calendar year.

Annual Report of the Internal Committee

Under Section 21 of the Sexual Harassment of Women at Workplace
(Prevention, Prohibition and Redressal) Act, 2013 read with Rule 14
For the Period: 1 January   to 31 December  

Part I — Employer / Organisation Details

Name of Organisation: 
Nature of Business / Sector: 
Registered Address: 
CIN / Registration No.: 
Total Number of Employees:     of whom Women: 
Name of Employer / Authorised Signatory: 

Part II — Internal Committee Details

Date of IC Constitution: 
Name of Presiding Officer: 
Name of External IC Member: 
Number of IC Members (total): 
Number of IC Meetings held during year: 

Part III — Complaints Received and Disposed

Sr. Nature of Complaint
(brief description, no names)		 Date Received Date of Inquiry Completion Status / Outcome Action Taken by Employer Remarks
1.      
2.      
3.      
4.      
5.      
Total Complaints Received: 
Complaints Pending from Previous Year: 
Complaints Disposed / Closed this Year: 
Complaints Pending at Year End: 
Complaints where conciliation was used: 
If no complaint was received during the year, state: "No complaint of sexual harassment was received by the Internal Committee during the year ending 31 December [Year]." The Annual Report must still be submitted to the District Officer even if no complaint was received.

Part IV — Awareness & Training Activities

Sr.Type of ActivityDateMode (Online / Offline)No. of ParticipantsTopics Covered
1.     
2.     
3.     

Part V — Declaration

We, the undersigned, hereby certify that the information contained in this Annual Report is true, complete, and correct to the best of our knowledge and belief, and that the Internal Committee has functioned in accordance with the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013 and Rules made thereunder during the reporting period.

Signature

Presiding Officer, IC
Name:  
Date:  
Signature

External IC Member
Name:  
Date:  
Signature & Seal

Employer / Authorised Signatory
Name:  
Date:  

Template provided by Embar Legal Advocates, Mysore (shebox.in). Submit to the District Officer / SHe-Box portal as prescribed. This document is for reference only — verify current format with the relevant district authority. Not legal advice.