Form IX — See Rule 24

FORM - IX
                                                                              (See rule 24)

   [(APPLICATION TO TRIBUNAL UNDER SECTION 59(2) OF THE INDUSTRIAL RELATIONS CODE, 2020
                                      BY WORKER)]

             Before the Central Government Industrial Tribunal at. ……….

              ............................................................. between......................... and.
.........................................................................................

(1) Name of the applicant(s) ……………………………………………………………………….

(2) Name of the employer ………………………………………………………………………….

              The           petitioner(s)        .................... a worker    of     ......................M/s.        ..............................of
.........................................The petitioner(s) undersigned, worker/workers of ............................ is/are entitled to receive
from the said M/s. .................................. the money /benefits mentioned in the statement hereto annexed.

             It is prayed that the Tribunal may be pleased to determine the amount /amounts due to the petitioner (s).

                                                                                                 Signature or thumb impression (s) of the applicant(s)

Address (es) ……………………………………………………..

Place......................................................

Date.........................................................

                                                                             ANNEXURE

         (Specify the details of the money due or the benefits accrued together with the case for their admissibility.)