The Uttar Pradesh Code on Social Security Rules, 2026
Form I
Official text
Open in the official PDF (p. 137)
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[ See clause (iii) of sub-rule (1) of rule 45 ]
Application for second appeal before Employee’s Insurance Court
Before the Employees' Insurance Court at…………………….............
AB (add description and address of applicant)
..................................................................................................................................
Against
CD (add description and address of opposite party/parties)
.................................................................................................................
Other Particulars of Application as specified in rule-45
1. …………………………………………
2. …………………………………………
3. …………………………………………
Date…………
Signature of Applicant
(Verification by the applicant)
The statement of facts contained in this application is, to the best of my knowledge and belief, true
and correct.
Date:………………
Signature of applicant