Form VI

(See rules 22, 41 and 42)

(AUTHORISATION BY WORKER, GROUP OF WORKERS, EMPLOYER OR GROUP OF EMPLOYERS TO BE

REPRESENTED IN PROCEEDING BEFORE THE AUTHORITY)

Before the authority

(Mention the authority concerned)

In the matter of:. (mention the name of the proceeding )

.............................................workers

Versus ………….................................................................................................employer

I/we hereby authorise Shri / Shrimati/Kumari ………………….to represent me/us in the above matter.

Dated this......................day of..............................20..........

Signature of person(s) nominating the representative(s)

Address

Accepted.

Signature of representative(s)

Address