The Code on Social Security (Lakshadweep) Rules, 2025
Form II
Official text
Open in the official PDF (p. 29)
Tables and forms lose their layout when extracted; the PDF is the authoritative version.
[See Rule 17 (1) (i)]
In the Employees, Insurance Court at ..........................................................
Applicant
(add description and residence) Against
....................................... Opposite Party (add description and residence) Other Particulars
of Application specified in rule 6(2)
Signature of Applicant
Date (verification by the applicant)
The statement of facts contained in this application is to the best of my knowledge and belief,
rue and correct.
Date ................