Form XXI

(See Rule 44, 46, 49 and 60)

(Notice of Intimation of Retrenchment/Closure to be given by an employer to State

Government under the provisions of Chapter IX of the Industrial Relation Code, 2020

and rules made thereunder)

(To be submitted online. In case of exigencies, on paper in the prescribed Format below)

Name of Industrial Establishment/Undertaking/Employer.........................................

Labour Identification Number/Registration Number........................Dated.................

(Note: The intimation for Closure/Retrenchment to the appropriate government shall be served 60 days

and 30 days before commencement of Closure/Retrenchment respectively)

To,

The Principal Secretary/Secretary, Department of Labour and Employment, Government of Arunachal

Pradesh, Itanagar.

*(Retrenchment) (a)Under Section 70(C) of this Code, I/we*hereby intimate you that I*/we*have decided to

retrench workers**out of a total of…….Workers**with............................... effect from ( D D / M M /

YYYY)

or*(Closure) (b) Under Section 74(1) of this Code, I/we* hereby intimate you that I*/we*have decided to

close down, (name of the industrial establishment or undertaking) with effect from.........................

(DD/MM/YYYY).The number of workers whose services would be terminated on account of the closure

of the undertaking is ........................................................................(number of workers)

1. There as on for Retrenchment/Closure is………………………………………

2. *The worker(s)*concerned were given on the ..................................................... (DD/MM/YYYY)

One month‘s notice in writing as required under section 70(a)*/section 75(1)*of this Code or The

worker(s) concerned have been given on the.......................................... (DD/MM/YYYY) one

month‘s pay in lieu of the notice as required under section 70(a)*/section 75(1)*of this Code.

3. *I*/We* hereby declare that the worker(s) concerned have been*/will be*paid all their dues alongwith

the compensation due to them under section 70* /section 75*of this Code before or on the expiry of

the notice period.

or

*I/We*hereby state that currently Insolvency proceedings are on in respect of the said Industrial

Establishment/Undertaking/Employer, and that I*/we* will pay all the dues alongwith the compensation

due to them under concerned laws.

4. (Retrenchment) I/we* hereby declare that the worker(s) concerned have been* / will be* retrenched in

compliance to the Section 71 and section 72 of this Code.

5. I*/ we* hereby declare that no court case is pending before any Court in the matter, and if yes, the

details the re of have been Annexed.

6. I*/ we* hereby declare that the above information given by me*/us* in this notice and the Annexure is

true, I*/we*am*/are*solely responsible for its accuracy and no facts/materials has been suppressed

in the matter.

Yours faithfully,

(Name of Employer/***Authorized

Representative with Seal)

(*Strike off which is not applicable.)

(**Indicate number in figures and words both)

(***Copy of Authorization letter issued by the employer shall been closed)

Copy to :

1. Labour Commissioner, Govt, of A.P

2. Secretary, Labour and Employment

3. District Labour Officer of concerned areas

4. To the Registered Unions/Authorised Representatives of Workers operating in the establishments

or undertakings.