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)

FOR…………. AREA…………

Application No……………………………………….of 20…….

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/Smt. ………

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(1) 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.

Signature or thumb-impression of the employed person(s),

or official of a registered trade union duly authorized or

Inspector- cum- Facilitator.

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