Form VIII

[APPLICATION BY A PERSON AUTHORISED BY A WORKER OR BY THE ASSIGNEE OR HEIR OF A DECEASED WORKER UNDER SECTION 59(1) OF THE INDUSTRIAL RELATIONS CODEDefined in rule 2(a): Code means the Industrial Relations Code, 2020 (35 of 2020), 2020]

To

Sir,

I Shri/Shrimati/Kumari......................... state that Shri/Shrimati/ Kumari......................... is/was entitled to receive from M/s................................. a sum of Rs. .................(in words) on account of............................. under the provisions of Chapter IX and X of the Industrial Relations CodeDefined in rule 2(a): Code means the Industrial Relations Code, 2020 (35 of 2020), 2020 (35 of 2020) /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 worker through.................. the duly elected representatives.

I further state that I served the management with a demand notice by speed post on.....................for the said amount which the management has neither paid nor offered to pay to me even though a fortnight has since elapsed. The details of the amount have been mentioned in the statement hereto annexed.

I request that the said sum may kindly be recovered from the management under sub-section (1) of sectionDefined in rule 2(d): section means a section of the Code. (2) Words and expressions used in these rules which are not defined, but are defined in the Code, shall have their respective meanings assigned to them in the Code. 59 of the Industrial Relations CodeDefined in rule 2(a): Code means the Industrial Relations Code, 2020 (35 of 2020), 2020 (35 of 2020), and paid to me as early as possible.

I have been duly authorised in writing by.....................(here insert the name of the worker) to make this application and to receive the payment of the aforesaid amount due to him.

I am the assignee/heir of the deceased worker and entitled to receive the payment of the aforesaid amount due to him.

Station......................... Signature of the authorised person/assignee/heirs

Date........................

Address.........................

ANNEXURE

(Specify the details of the amount claimed.)