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, New Delhi.
(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)