Form VIII

Made under The Industrial Relations Code, 2020G.O.Rt. No. 111, 12 Jun 2026

Official text

Open in the official PDF (p. 46)

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(See rule 26)

(APPLICATION BY A PERSON AUTHORISED BY A WORKER OR BY THE ASSIGNEE OR

HEIR OF ADECEASED WORKER UNDER SUB-SECTION (1) OF SECTION 59 OF THE

INDUSTRIAL RELATIONSCODE, 2020)

(1) The Principal Secretary, Labour, Factories, Boilers and Insurance Medical

Services Department, Government of Andhra Pradesh, AP Secretariat,

VELAGAPUDI, Guntur Dt.

(2) The Deputy Commissioner of Labour (here insert the name of the District).

Sir,

I Shri/Shrimati/Kumari..............................................................have to 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 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 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 am entitled to receive the

payment of the aforesaid amount due to him.

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

Date…………….........

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

Source: The Industrial Relations (Andhra Pradesh) Rules, 2026, G.O.Rt. No. 111 — Andhra Pradesh Gazette Extraordinary (as ordered by G.O.Rt. No. 111), p. 46 of the PDF. Open our copy at p. 46 · official download · all sources

Text from the Government Order that orders the notification's publication in the Andhra Pradesh Gazette; the Gazette issue itself was not found on the AP e-Gazette.