Form VIII

(See rule 24)

[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 CODE, 2020]

To

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

(2) The Deputy Chief Labour Commissioner (Central).....................(here insert the name of the region).

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 Code, 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 section 59

of the Industrial Relations Code, 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.........................