Form XI

(see rule 38)

(COMPLAINT UNDER SECTION 91 OF THE INDUSTRIAL RELATION

CODE, 2020)

Before the Conciliation officer/ Arbitrator/ 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 Relation 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 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

Relation Code 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.