Form XVII

(see rule 46 and 48)

Notice of Intimation of Retrenchment/ Closure to be given by an employer to

the State Government under the provisions of Chapter IX of the Industrial

Relations Code, 2020 and rules made there under

( To be submitted online. In case of exigencies, on paper in the prescribed format below)

Name of Industrial Establishment /Undertaking/ Employer.........................................

Labour Identification Number .......................................................................................

Dated.................

( Note: The intimation for Closure/Retrenchment to the appropriate government shall be

served 60 days and 30 days before commencement of Closure/Retrenchment respectively

)

To,

The Secretary to the Government ofRajasthan, Labour Department

Jaipur

1. *(Retrenchment) (a) Under Section 70(C) of this Code, I/ we* hereby intimate you that

I*/we* have decided to retrench.................................. workers** out of a total of …….

Workers** with effect from…………….. (DD/MM/YYYY)

Or

*(Closure) (b) Under Section 74(1) of this Code, I / we* hereby intimate you that I*/we*

have decided to closedown,............................(name of the industrial establishment or

undertaking) witheffect from......................... (DD/MM/YYYY). The number of

workers whose services would be terminated on account of the closure of

theundertakingis.............................................(number of workers)

2. ThereasonforRetrenchment/Closureis………………………………………………………….

……………………………………………………………………………………………………

……………………………..…………………………………………………………………….

3. *Theworker(s)*concernedweregivenonthe..................(DD/MM/YYYY)onemonth‘snoticein

writing as required under section 70(a)*/ section 75(1)* of this Code.

or

* The worker(s) concerned have been given onthe.....(DD/MM/YYYY) one month‘s

pay in lieuof the notice as required under section 70(a)*/ section 75(1)* of this Code.

4. * I*/We* hereby declare that the worker(s) concerned have been*/will be* paid all their dues

along with the compensation due to them under section 70* / section 75* of this Code before

or on the expiry of the noticeperiod.

or

*I/We* hereby state that currently Insolvency proceedings are on in respect of the said

Industrial Establishment/Undertaking/Employer, and that I*/we* will pay all the dues

along with the compensation due to them under concernedlaws.

5. (Retrenchment) I/we* hereby declare that the worker(s) concerned have been* / will be*

retrenched in compliance to the Section 71 and section 72 of thisCode.

6. I*/ we* hereby declare that no court case is pending before any Court in the matter,

and if yes, the details thereof have beenAnnexed.

7. I*/ we* hereby declare that the above information given by me*/us* in this notice and the

Annexures is true, I*/ we* am*/ are* solely responsible for its accuracy and no facts/ materials

has been suppressed in thematter.

Yoursfaithfully,

(Name of Employer/ ***AuthorizedRepresentative

withSeal)

(* Strike off which is not applicable.)

(** Indicate number in figures and words both)

(***Copy of Authorization letter issued by the employer shall be enclosed)

Copy to :

(1) Labour Commissioner, Rajasthan, Jaipur

(2) Labour Welfare Officer, Asst. / Dy / Joint Labour Commissioner of the

concernedarea……….

(3) To the Registered Unions/ Authorised Representatives of Workers operating in the

establishments or undertakings.