Industrial Disputes (Central) Rules, 1957

FORM K3 : Recovery of Dues

[Rule 62(2)]

Application under sub-section (2) of section 33C of the Industrial Disputes Act, 1947

Before the Central Government Labor Court at _______________________________

Between ______________________ Applicant (s)

And ______________________ Employer

The petitioner , ____________________ a workman of ___________________ M/s , ___________________ of _______________ The petitioners undersigned, workmen of _________________ is / are entitled to receive from the said M/s _____________________ the money / benefits mentioned in the statement hereto annexed.

It is prayed that the Court be pleased to determine the amount / amounts due to the petitioner (s).

Z  Signature or thumb impression (s) of the applicant (s)

____________________________________________.

Address( es )___________________________________

_____________________________________

1.

2.

3.

4.

Station _____________

Date _______________

ANNEXURE

(Set out the details of the money due or the benefits accrued together with the case for their admissibility)