Form VII

(See rule 26)

(APPLICATION UNDER SUB-SECTION (1) OF SECTION 59 OF THE INDUSTRIAL RELATIONS

CODE,2020)

To,

(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/We have to state that I am/we are 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/We further state that I/we 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/us even though a fortnight has since

elapsed. The details of the amount have been mentioned in the statement hereto

annexed.

I/We request that the said sum may kindly be recovered for the

management under sub-section (1) of section59 of the Industrial Relations Code,

2020 (35 of 2020) and paid to me/us as early as possible.

Signature of the applicant(s)

Address(es)

Station:

Date:.