Form X — Application Under Section 59(2) Of The Industrial Relations Code, 2020 By Assignee/

FORM- X
                                                                [See rule 24]

   (APPLICATION UNDER SECTION 59(2) OF THE INDUSTRIAL RELATIONS CODE, 2020 BY ASSIGNEE/
                               HEIR OF DECEASED WORKER)

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

(i) Name of the applicant/applicants ……………………………………………….

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

             I am/We are the assignee(s) of the deceased worker and am/are entitled to make an application on his behalf.

         Shri/Smt................... former worker of M/s .......................... of........................is entitled to receive from the
said M/s............................ the money/benefits mentioned in the statement hereto annexed;

             It is prayed that the Tribunal be pleased to determine the amount/amounts due to the deceased worker.

Name and Address of worker..........................

                                                                                                         Signature of the assignee/heirs

Address (es) ……………………………………………………..

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

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

                                                                ANNEXURE

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