198 E Orissa Industrial Disputes Rules,1959 (F

198 E ORISSA INDUSTRIAL DISPUTES RULES,1959 (F.T_3)

FORM T-3

(See Rule 69 (2)

Application under sub section (2) of section 33-C of the Industrial Dispute Act, 1947.

Before the Labour Court at_____ Between (1) Name of the applicant(s)______(2) Name of the employer ______. The petitioner ______a workman of ____ the petitioner's undersigned workmen of Messrs______of is/are entitled to receive from the said Messrs______the money/benefits mentioned. In the statement amounts due to the petitioned (s)

It is prayed that the Court be pleased to determine the amounts due to the petitioner (s).

Station______Signature or thumb impression (s) (Address) of the applicant.

Date.______

ANNEXURE

(Here set out the details of the money dueor the benefits accrues together with the case for their admissibility)