The Industrial Relation (Arunachal Pradesh) Rules, 2021
Form XVIII
Official text
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[See rule 41 (2)]
Application by a person who is an assignee or heir of a deceased worker under
sub-section (2) of section 59 of the Industrial Relations Code, 2020 (35 of 2020)
Before the State Government Industrial Tribunal at................................ Between
(i) Name of the applicant/applicants ………………………………………………........
(ii) Name of the employer …………………………………………………………………..
I am/We are the assignee(s) of the deceased worker and am/are entitled to make an application on
his behalf.
Shri......................... former worker of M/s ..........................of........................is entitled to receive
from the said M/s............................ the money/benefits mentioned in the statement hereto annexed;
It is prayed that the Tribunal be pleased to determine the amount/amounts due to the deceased
worker.
Name and Address of worker..........................
Signature of the assignee/heirs
Address (es) ……………………………………………………..
Place......................................................
Date.........................................................