Industrial Disputes (Central) Rules, 1957
Application under sub-section (1) of section 33C of the Industrial Disputes Act, 1947
(i) Secretary to
the Govt. of India Ministry of Labor and Employment,
(ii) The Regional Labor Commissioner (Central) __________________ (Name of the region).
I / We have to state that I am / we are entitled to receive from M/s ______________________ a sum of Rs. _________________ on account of under the provisions of Chapter V-A / Chapter V-B of the Industrial Disputes Act, 1947 / in terms of the award dated the _____________ given by _____________ / in terms of the settlement dated the __________ arrived at between the said M/s ________________________ and their workmen through ___________ the duly elected representatives.
I / We further state that I / we served the management with a demand notice by registered post on _______________ for the said amount which the management has neither paid nor offered to pay to me/us even though a fortnight has since elapsed. The details of the amount have been mentioned in the statement hereto annexed.
I / We request that the said sum may kindly be recovered from the management under subsection (1) of section 33C of the Industrial Disputes Act, 1947, and paid to me / us as early as possible.
Signature of the applicant(s) ________________________ Address (es) ____________________
(Indicate the details for the amount(s) claimed)