Form XXIV (See Rule 56)

(Complaint under Section 91 of the Industrial Relations Code, 2020 (35 of 2020))

Before the Conciliation officer/ Arbitrator/ Tribunal or, State Industrial Tribunal ............................., In the

matter of:................................... Reference.

No…………………………………….

A...................... Complainant(s);

Versus

B...................... Opposite Party(ies).

Address:

The petitioner(s) begs/beg to complain that the Opposite Party(ies) has/have been guilty of a

contravention of the provisions of section 90 of the Industrial Relations Code, as shown below: (Here set

out briefly the particulars showing the manner in which the alleged contravention has taken place and the

grounds on which the order or act of the management is challenged).

The complainant(s) accordingly prays/pray that the Conciliation officer/ Arbitrator/ Industrial Tribunal

or State Industrial Tribunal may be pleased to decide the complaint set out above and pass such order or

orders thereon as it may deem fit and proper.

The number of copies of .the complaint and its annexure required under rule 91 of the Industrial Relations

Code, 2020 (35 of 2020) are submitted herewith.

Dated this............day of............20..... Signature of the Complainant(s)

Verification: - I do solemnly declare that what is stated in paragraph.......... above is true to my knowledge

and that what is stated in paragraphs........ above is stated upon information received and believed by me

to be true. This verification is signed by me at.................... on ............ day of .............................

20.....................

Signature or Thumb impression of the person

verifying.

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