Form XX

(see rule 58)

Complaint under Section 91 of the Industrial Relations Code, 2020) Before the

Conciliation officer/ Arbitrator/ Tribunal or,NationalTribunal------------- ,

In the matter of :...................... Reference No…………….

A...................... Complainant(s);

Versus

B...................... Opposite Party(ies).

The petitioner(s) begs/beg to complain that the Opposite Party(ies) has/have been guilty

of a contravention of the provisions of section 90 of the Industrial Relations code, as

shown below:

(Here set out briefly the particulars showing the manner in which the alleged

contravention has taken place and the grounds on which the order or act of the

management is challenged.)

The complainant(s) accordingly prays/pray that the Conciliation officer/ Arbitrator/

Industrial Tribunal or National Tribunal may be pleased to decide the complaint set out

above and pass such order or orders thereon as it may deem fit and proper.

The number of copies of .the complaint and its annexure required under rule 91 of the

Industrial Relations Code are submitted herewith.

Dated this............day of............20……..

Signature of the Complainant(s)

Verification

I do solemnly declare that what is statedinparagraph.................…above is true tomy

knowledge and that what is statedinparagraphs............................above is stated upon

information receivedand

believedbymetobetrue.Thisverificationissignedbymeat.........................on

……day…….of.............20.....................

Signature or Thumb impression of the person verifying.

[S.No. F.14(1)(5)Industrial Relations/ Code/Shram/Vidhi/2021]