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Form guide · Source checked 21 October 2026
Industrial Relations Form XIV: Chapter X permission application
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Application for prior permission for lay-off, continuation, retrenchment or closure, with establishment and affected-worker annexures.
(See rules 30, 31, 33 and 35) · Industrial Relations (Central) Rules, 2026 · Central-sphere scope
Download and read the completed example
Completed fictional chapter x permission application concerning Illustration Central Engineering Ltd (fictional), 14 Example Works, New Delhi 110001. The selected legal route and inapplicable alternatives are identified below.
Fictional, unsigned completed illustration. It demonstrates this form’s fields; it is not a filed return, medical opinion, official order or proof of an actual transaction.
When and how this form is used
The prescribed application note distinguishes advance application periods: lay-off at least 15 days; continuation at least 15 days before existing lay-off expiry; retrenchment at least 60 days; closure at least 90 days. Each route has its own Code conditions and worker-notice/compensation requirements.
The model selects temporary lay-off and completes both annexures, including every affected worker. The 21-day interval meets the illustrated application lead-time only; it does not supply permission or establish that the substantive grounds are accepted.
The completed fields
Selected lay-off application
| Prescribed field / section | Completed fictional entry |
|---|---|
| Establishment / LIN / date | Illustration Central Engineering Ltd (fictional), 14 Example Works, New Delhi 110001; [synthetic LIN]; 20 October 2026 |
| Chapter X assumption | Factory with 350 workers employed on the assumed applicable average basis; covered by Chapter X; no exemption assumed |
| 1 a. Lay-off | Permission sought for twenty (20) of three hundred fifty (350) workers from 10 November 2026 for 15 days due to a documented temporary raw-material supply interruption |
| Other routes / worker notice | Continuation, retrenchment and closure branches N/A; affected-worker notice assumed given 20 October 2026 |
| 2. Affected list | All 20 fictional workers in Annexure II below; no partial list |
| 3. Retrenchment selection declaration | N/A: lay-off selected |
| 4. Dues / compensation | Pay statutory lay-off compensation and other applicable dues under section 67 read with section 78(10); no payment exemption assumed |
| 5–6. Cases / declaration / signatory | No pending court case assumed; Kavita Shah, authorised director; Unsigned fictional illustration; no seal, filing acknowledgement or authority act executed |
| Prayer | Grant the legally required permission; no permission or deemed approval asserted |
Annexure I — establishment and justification
| Prescribed field / section | Completed fictional entry |
|---|---|
| 1–3. Address / entity / licence / CIN / GSTIN | Illustration Central Engineering Ltd (fictional), 14 Example Works, New Delhi 110001; Central-sphere public-sector engineering company assumed; registration/CIN/GSTIN [synthetic]; engineering components |
| 4 i. Preceding 3 annual production figures | 2023: 12,000 units; 2024: 12,500; 2025: 13,000; fictional production records, not certified accounts |
| 4 ii. Preceding 12 monthly figures | October 2025 through September 2026: 1,000 units each month, total 12,000 |
| 5. Audit accounts | Actual last-three-year audited financial statements required; none fabricated in sample |
| 6. Connected companies | None on assumed facts |
| 7. Intended lay-off reasons | Single raw-material supplier interruption expected to last 15 days; inventory and order records would support the actual case |
| 8. Last-three-year lay-off / retrenchment | None assumed; no previous period/number to report |
| 9. Other relevant facts | Application is a request; production planning does not authorise lay-off before lawful permission |
Annexure II — all twenty affected workers
| Prescribed field / section | Completed fictional entry |
|---|---|
| 1. Ravi Kumar (fictional) | UAN [synthetic DEMO-UAN-01]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 2. Asha Verma (fictional) | UAN [synthetic DEMO-UAN-02]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 3. Neha Das (fictional) | UAN [synthetic DEMO-UAN-03]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 4. Arun Mehta (fictional) | UAN [synthetic DEMO-UAN-04]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 5. Priya Rao (fictional) | UAN [synthetic DEMO-UAN-05]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 6. Rohan Rao (fictional) | UAN [synthetic DEMO-UAN-06]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 7. Anita Sen (fictional) | UAN [synthetic DEMO-UAN-07]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 8. Kiran Shah (fictional) | UAN [synthetic DEMO-UAN-08]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 9. Meera Joshi (fictional) | UAN [synthetic DEMO-UAN-09]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 10. Vivek Patel (fictional) | UAN [synthetic DEMO-UAN-10]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 11. Sunita Rao (fictional) | UAN [synthetic DEMO-UAN-11]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 12. Dev Mehta (fictional) | UAN [synthetic DEMO-UAN-12]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 13. Nisha Das (fictional) | UAN [synthetic DEMO-UAN-13]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 14. Rahul Sen (fictional) | UAN [synthetic DEMO-UAN-14]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 15. Pooja Shah (fictional) | UAN [synthetic DEMO-UAN-15]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 16. Amit Joshi (fictional) | UAN [synthetic DEMO-UAN-16]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 17. Leena Patel (fictional) | UAN [synthetic DEMO-UAN-17]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 18. Sanjay Rao (fictional) | UAN [synthetic DEMO-UAN-18]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 19. Maya Mehta (fictional) | UAN [synthetic DEMO-UAN-19]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
| 20. Ajay Das (fictional) | UAN [synthetic DEMO-UAN-20]; skilled production worker; service from 1 April 2020; wage at application ₹26,000/month; temporary supply-interruption lay-off proposed |
Supporting records and reconciliation
Actual workforce/applicability history, complete worker list, production figures, audited accounts, supply/financial reasons, worker communication, authority of applicant and actual permission decision.
Worked calculation: 20 affected out of 350; monthly production 12 × 1,000 = 12,000 units; intended date 21 days after application.
Official source and version
Official Ministry of Labour Gazette PDF, Form XIV, PDF pages 87–89
Industrial Relations Code 2020, actual relevant sections; Gazette Act 35 of 2020
Act 1 of 2026, section 2 substitutes section 104 repeal/authority continuity
Download the official source pages containing this form. Adjacent prescribed forms can share a source page; use the heading and rule identified above.
These are Central Rules. Use the actual appropriate government and authority. The 2026 amending Act substitutes section 104’s repeal/continuity provisions and continues existing Tribunals/statutory authorities until the Code authorities function: https://egazette.gov.in/WriteReadData/2026/270186.pdf. Enacted Code: https://egazette.gov.in/WriteReadData/2020/222118.pdf
Practical questions
Can I submit the sample as my own completed form?
No. Replace the fictional facts with accurate records, use the competent filing or record-keeping route described above and complete genuine signatures or certifications where required.
What makes the example specific to this form?
Application for prior permission for lay-off, continuation, retrenchment or closure, with establishment and affected-worker annexures.