The Uttar Pradesh Code on Wages Rules, 2026
Form IV
Official text
Open in the official PDF (p. 65)
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[See Sub-rule (2) of Rule 44]
CERTIFICATE OF AUTHORISATION
I/We employed person(s) hereby authorize Sri/Smt/Ku. ………………….. , a legal practitioner
……………………… / Sri/Smt/Ku. ………………….an official of ........................... which is a registered
Trade Union to Act on my/our behalf under section 45 or Section 49 of the Code on Wages 2019 (29 of
2019), in respect of the claim/ appeal against .......................... on account of the difference between wages
payable and actually paid under the Code/ payment of remuneration of days of rest/ payment of wages at
the overtime rates/ delay in payment/ illegal deductions from my/our wages/ non-payment of
bonus for................
Witnesses: Signature:
(1) (1)
(2) (2)
(3) (3)
(4) (4)
Date:
Place:
I accept the authorisation.
Signature of authorized person/
Legal practitioner/ Official of a
registered trade union with Seal.