Form XVI,

(See rule 41)

Application under sub-section (1) of section 59 of the Industrial Relations Code,

2020

To,

(1) The Secretary / Principal Secretary / Additional Chief Secretary to the Government of

Bihar, Labour Resources and Migrant Workers Welfare Department.

(2) The Deputy Labour Commissioner ....................... (here insert the name of the region).

Sir,

I/We have to state that I am/we are entitled to receive from M/s

...................................a sum of Rs. .............(in words) on account of ................ under the

provisions of Chapter IX and X of the Industrial Relations Code, 2020/in terms of the

award dated the.................... given by..................... /in terms of the settlement dated the

..................... arrived at between the said M/s ......................... and their worker

through........................... the duly elected representatives.

I/We further state that I/we served the management with a demand notice by

registered post on ..................... for the said amount which the management has neither

paid nor offered to pay to me/us even though a fortnight has since elapsed. The details of

the amount have been mentioned in the statement hereto annexed.

I/We request that the said sum may kindly be recovered for the management under

sub-section (1) of section 59 of the Industrial Relations Code, 2020 and paid to me/us as

early as possible.

Signature of the applicant(s)

Address(es)

Station:

Date:.