The Code on Social Security (Lakshadweep) Rules, 2025
Form I
Official text
Open in the official PDF (p. 28)
Tables and forms lose their layout when extracted; the PDF is the authoritative version.
[See rule 16]
Appeal to Employees' Insurance Court
To
Sir,
The Authority,
(Appointed under the Code on Social Security,2020)
(Address)
I. ......., the undersigned, employee of (Name and full address of the
establishment)
*Feel aggrieved by the order of under sub section 7(a) of section 37 for the reasons
attached hereto, prefer this second appeal under sub-section 7(b) of section 37 and request
that the said be ordered
A copy of the order
of in this behalf is enclosed.
Date .......................
Signature or thumb impression of the Aggrieved person
Signature of an Attester in case the person
is not able to sign and affixes thumb impression