The Industrial Relation (Arunachal Pradesh) Rules, 2021
Form XVII
Official text
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[See rule 41 (2) ]
Application under sub-section (2) of section 59 of the Industrial
Relations Code, 2020 (35 of 2020)
Before the State Government Industrial Tribunal at. ……….
between.................................................. and. ..............................................
(1) Name of the applicant(s) ……………………………………………………………………….
(2) Name of the employer ………………………………………………………………………….
The petitioner(s) ....................a worker of ......................M/s. ..............................of
.........................................The petitioner(s) undersigned, worker/workers of ............................ is/are
entitled to receive from the said M/s. .................................. the money /benefits mentioned in the statement
hereto annexed.
It is prayed that the Tribunal may be pleased to determine the amount /amounts due to the
petitioner (s).
Signature or Thumb Impression (s) of the applicant(s)
Address (es) ……………………………………………………..
Place......................................................
Date.........................................................