Form II — Application To Tribunal

FORM - II
                                    [See sub-rule (8) of rule 9/ sub-rule (9) of rule 23]

                                            (APPLICATION TO TRIBUNAL)

Before the Central Government Industrial Tribunal -------------------------------------------------------------------(place of the
Industrial Tribunal having jurisdiction where dispute arises)

(A) Name and address of applicant(s)

 Versus

(B) Name and address of opposite party(ies)

Brief facts of the dispute (statement regarding specific issues of dispute may be mentioned) which are connected with
and relevant to the dispute under sub-section (1) of section 22/sub-section (6) of section 53* of the Industrial Relations
Code, 2020 (35 of 2020).

                                                             Prayer:

The applicant(s) pray(s) that instant application may be admitted for adjudication and request(s) to pass appropriate
award in the matter.

                                                                                     Name and signature of the worker(s) or
                                                                 Officer of Trade union raising the dispute/Party in dispute*

(* strike off which is not applicable)