Form XV

[See clause (a) of sub-rule (2), sub-rule (3) and (4) of rule-55]

Notice for Appearance before the Competent Authority/Summon

(Strike out the words not applicable)

To,

…………………………..

Whereas Shri ................................an employee under you/a nominee(s)/legal

heir(s) of Shri........................................an employee under the above-mentioned employer, has/have filed an

application under sub-rule (1) of rule 55 of the Uttar Pradesh Code on Social Security Rules, 2021 alleging that-

(A copy of the said application is enclosed, if, summon is issued then copy of application is not required)

Now, therefore, you are hereby called upon/summoned to appear before the Competent Authority at (place)

either personally or through a person duly authorized in this behalf for the purpose of answering all material

questions relating to the application on the …….... day of ............20 at ................ 'O' clock in the

forenoon/afternoon in support of/to answer the allegation;

and as the day fixed for your appearance is appointed for final disposal of the application, you must be

prepared to produce on that day all the witnesses upon whose evidence, and the documents upon which you

intend to rely in support of your allegation/ defence.

Take notice that in default of your appearance on the day before-mentioned, the application will be

dismissed/heard and determined in your absence.

Whereas your attendance is required to give evidence/you are required to produce the documents

mentioned in this list below, on behalf of................................................................................................ in the

case arising out of the claim for gratuity by.......... form................. and referred to this Authority by an

application under section 56 of the Code on Social Security, 2020, you are hereby summoned to appear

personally before this Authority on the ............. day of

................20................. at...................................................................... ‘O’clock in the forenoon/afternoon and to

bring with you for to send to this Authority, the said documents. List of documents-

1.

2.

3.

Given under my hand and seal, this ..............day of ..............20.....

Competent Authority under

the Code on Social Security Code, 2020

NOTE:

1. Strike out the words and paragraphs not applicable.

2. The portion not applicable to be deleted.

3. The summons shall be issued in duplicate. The duplicate is to be signed and returned by the persons served

before the date fixed.

4. In case the summons is issued only for producing a document and not to given evidence it will be sufficient

compliance to the summons if the documents are caused to be produced before the Competent authority on

the day and hour fixed for the purpose.