Form K‑1
[See rule 6(1)]

Application under sub‑section (1) of section 33C of the Industrial Disputes Act, 1947

To

(1) The Secretary to the Government of India, Ministry of Labour and Employment, New Delhi.
(2) The Regional Labour Commissioner (Central) …………….. (here insert the name of the region).

Sir,

I/We have to state that I am/we are entitled to receive from M/s ……………..a sum of Rs ……………..on account of……………..under the provisions of Chapter V‑A/Chapter V‑B of the Industrial Disputes Act, 1947 in terms of the award dated the ……………………given by ……………..in terms of the settlement dated the ……………..arrived at between the said M/s . ……………..and their workmen through……………..the duly elected representatives.

I/We further state that I/we served the management with a demand notice by registered post on……………..for the said amount which the management has neither paid nor offered to pay to me/us even though a fortnight has since elapsed. The details of the amount have been mentioned in the statement hereto annexed.

I/We request that the said sum may kindly be recovered from the management under sub‑section (1) of section 33C of the Industrial Disputes Act, 1947, and paid to me/us as early as possible.

Signature of the applicant(s) Address(es)

Station…………….. 1 .

Date…………….. 2.
3.
4.
ANNEXURE
[Here indicate the details of the amount(s) claimed.]