Form XII

Made under The Industrial Relations Code, 2020S.O. 41, 12 Aug 2026

Official text

Open in the official PDF (p. 34)

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(see rule 42)

Application to be submitted before the Tribunal in the matter not settled by the

Conciliation Officer

Before…………… (here mention the name of the Tribunal having jurisdiction over the

area) In the matter of:

............................................ Applicant

Address.................................................

Versus

.................................................................. Opposite party (ies)

Address......................................................

The above mentioned applicant begs to state as follows :-

(Here set out the relevant facts and circumstances of thecase).

The applicant prays that the instant dispute may please be admitted for adjudication and

request to pass appropriate Award.

Date …......

Place .........

(Signature)

Source: The Rajasthan Industrial Relation Rules, 2026, S.O. 41 — Rajasthan Gazette Extraordinary, Part 4 (Ga), Sub-section (II), p. 34 of the PDF. Open our copy at p. 34 · official download · all sources