Form XVI

(See rule 42)

(COMPLAINT UNDER SECTION 91 OF THE INDUSTRIAL RELATIONS CODE, 2020)

Before the Conciliation officer/ Arbitrator/ Tribunal or, National Industrial

Tribunal --------------------------------------------,In the matter of:...............................

Reference No…………………………………

A...................... Complainant(s);

Versus

B...................... Opposite Party(ies).

Address:

The petitioner(s) begs/beg to complain that the Opposite Party(ies) has/have been

guilty of a contravention of the provisions of section 90 of the Industrial Relations

Code, 2020 as shown below:

(Here set out briefly the particulars showing the manner in which the alleged

contravention has taken place and the grounds on which the order or act of the

management is challenged.)

The complainant(s) accordingly prays/pray that the Conciliation officer/

Arbitrator/ Industrial Tribunal or National Industrial Tribunal may be pleased to

decide the complaint set out above and pass such order or orders thereon as it

may deem fit and proper.

The number of copies of the complaint and its annexure required under rule 43 of

the Industrial Relations Code, 2020(35 of 2020) are submitted herewith.

Dated this............day of............20..... Signature of the Complainant(s)

Verification

I do solemnly declare that what is stated in paragraph.......... above is true to my

knowledge and that what is stated in paragraphs........ above is stated upon

information received and believed by me to be true. This verification is signed by

me at.................... on ............day of....................20.....................

Signature or Thumb impression of the person verifying.