The Code on Social Security (Arunachal Pradesh) Rules, 2021
Form IV
Official text
Open in the official PDF (p. 46)
Tables and forms lose their layout when extracted; the PDF is the authoritative version.
[See Rule 25]
In the Employees Insurance Court at ___________________ .
1. Name with full address of Applicant :
Against
2. Name with full address of Opposite party.
Other particulars of the application specified in Rule-25.
Date :
Signature of the Applicant
(Verification by the Applicant)
The statement of facts contained in this application are to the best of my knowledge and belief to be true
and correct. application is
Date :
Signature.