Form XV

[ See rule 41 (1)]

(Application under sub-section (1) of section 59 of the Industrial Relations Code, 2020)

To,

(1) The Secretary to the Government of Arunachal Pradesh, Labour and Employment,

Department, Itanagar.

(2) The Deputy Labour Commissioner, Arunachal Pradesh, Itanagar.

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/ 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 section 59 of the Industrial Relations Code, 2020 and paid to me/us as early as possible.

Signature of the applicant(s)

Address(es)

Station:

Date:.