The Code on Wages (Rajasthan) Rules, 2026
Form III
Official text
Open in the official PDF (pp. 21–23)
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(see rule 41)
Appeal under Section 49 (1) of the Code on Wages, 2019
Before the Appellate Authority under the Code on Wages, 2019
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(Name and Address of appellant)
Vs.
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(Name and Address of respondent)
DETAILS OF APPEAL:
1. Particulars of the order against which the appeal is made : Number and
date:
The authority who has passed the impugned order:
Amount awarded:
Compensation awarded , if any :
2. Facts of the case:
(Give here a concise statement of facts in a chronological order, each paragraph
containing as nearly as possible a separate issue or fact).
3. Grounds for appeal:
4. Matters not previously filed or pending with any other Court or any
AppellateAuthority:
The appellant further declares that he had not previously filed any appeal, writ
petition or suit regarding the matter in respect of which this appeal has been
made, before any Court or any other Authority or Appellate Authority nor any
such appeal, writ petition or suit is pending before any of them.
5. Reliefs sought :
In view of the facts mentioned above the appellant prays for the following
relief(s) :— [Specify below the relief(s) sought]
6. List ofenclosures:
1.
2.
3.
4.
Date :
Place :
Signature of the appellant.
For office use
Date of filing or
Date of receipt by post Registration No.
Authorized Signatory