Form K2 Rule 62(1)

APPLICATION FOR RECOVERY OF ANY AMOUNT FROM AN EMPLOYER UNDER ANY REWARD OR SETTLEMENT BY AN ASSIGNEE/HEIR OF THE WORKMAN

Application by a person authorised by a workman or by the assignee or heir of a deceased workman under subsection (1) of Section 33-C of the Industrial Disputes Act, 1947

To,

(1) The Secretary to the Government of India, Ministry of Labour and Employment, New Delhi

(2) The Regional Labour Commissioner (Central)………………. (Here insert the name of the Region.)

Sir,

I, Shri/Shrimati/Kumari ………… have to state that Shri/Shrimati/Kumari …………… is/was 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 ……….
/in terms of the settlement dated the …………. arrived at between the said M/s ……………… and their workmen through the duly elected representatives.

I further state that I 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 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 Section 33-C of the Industrial Disputes Act, 1947, and paid to me as early as possible.

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

* I am the assignee/heir of the deceased workman and am entitled to receive the payment of the aforesaid. Amount due to him.

* - Strike out the portions inapplicable

Station: ……………..

Date: ………………

Signature of the applicant

Address ………………

…………………………

ANNEXURE

………………………………………………………………………………………………

(Here indicate the details of the amount claimed)