Form K1 Rule 62(1)

APPLICATION FOR RECOVERY OF ANY AMOUNT FROM AN EMPLOYER UNDER ANY REWARD OR SETTLEMENT

Application under sub-section (1) of Section 33-C of the Industrial Disputes Act, 1947

To,

• Secretary to the Government of India, Ministry of Labour and Employment, New Delhi.
• The Regional labour Commissioner (Central), ……………… (here insert the name of the region).

Sir,

I/We have to state that I’m/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 sub-section (1) of Section 33-C of the Industrial Disputes Act, 1947, and paid to me/us as early as possible.

	Signature of the applicant(s)	Address(es)
1.
2.
3.
4.

Station: …………....

Date: ………………

ANNEXURE
…………………………………..……………………………………………………

(Here indicate the details of the amount(s) claimed)