Form II

[See rule 48]

[SINGLE APLICATION UNDER SUB-SECTION (5) OF SECTION 45]

Before the Authority Appointed Under Sub Section (1) of Section 45

of the Code on Wages, 2019 (29 Of 2019)

FOR…………………….. AREA………………..

Application No………………………………………….of 20…………………………………......….

Between ABC and (State the number)……......… other…………………………......………………….

Applicant (Through employees concerned or registered trade union or Inspector- cum- Facilitator)

Address………………………………………………………………………………………................…….

And

XYZ……….......................………………………………………………………………………………………...

Address…………..................………………..

The application states as follows:

(1) The applicant(s) whose name(s) appear in the attached schedule was/were/has/have been

employed from……………to……...........as……………...(category) in…......………….(establishment)

Shri/M/s………................................engaged in…….........................…….(nature of work) which

is/are covered by the Code on Wages, 2019.

(2) The opponent(s) is/are the employer(s) within the meaning of section 2(l) of the Code on Wages,

2019.

(3) (a) The applicant(s) has/ have been paid wages at less than the minimum rates of wages fixed

for their category(categories) of employment(s) under the Code by `….……….........…..Per

day for the period(s) from…….......…………………to……….........……………….

(b) The applicant(s) has/ have not been paid wages at `…………….. Per day for the weekly

days of rest from…………...........……..to.................................…

(c) The applicant(s) has/ have not been paid wages at overtime rate(s) for the period

from………………..…..to…....................

(d) The applicant(s) has/have not been paid wages for period from ………………to……........….

(e) Deductions have been made which are in contravention of the Code, from the wage(s) of the

applicant(s) as per details specified in the annexure appended with this application.

(f) The applicant(s) has/have not been paid minimum bonus for the accounting year

………..................................................……..

(4) The applicant(s) estimate(s) the value of relief sought by him/ them on each amount as under:

(a) `……………..

(b) `……………..

(c) `……………..

Total `……………..

(5) The applicant(s), therefore, pray(s) that a direction may be issued under section 45(2) of the Code

on Wages, 2019 for;

(a) payment of the difference between the wages payable under the Code and the wages

actually paid,

(b) payment of remuneration for the days of rest

(c) payment of wages at the overtime rates,

(d) compensation amounting to `……………............................

(6) The applicant(s) do hereby solemnly declare(s) that the facts stated in this application are

true to the best of his/their knowledge, belief and information.

Dated……........................…….

Signature or thumb-impression of the employed

person(s), or official of a registered trade union

duly authorized or Inspector- cum- Facilitator.

Note : The applicant(s), if required, may append annexure containing details, with this application.