Form II

[See rule 39]

[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)

Application No………………………. of20……

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 Rs….

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

(b) The applicant(s) has/have not been paid wages at Rs……………..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) Rs…….

(b) Rs…….

(c) Rs…….

Total Rs…….

(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 Rs………………………

(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 unionduly

authorized or Inspector- cum- Facilitator.

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

application.