Form XIV — See Rules 30, 31, 33 And 35

FORM- XIV
                                                             (See rules 30, 31, 33 and 35)

(APPLICATION FOR PERMISSION TO LAY-OFF/CONTINUATION OF LAY-OFF/ RETRENCHMENT/
CLOSURE TO THE CENTRAL GOVERNMENT UNDER CHAPTER X OF THE INDUSTRIAL RELATIONS
CODE, 2020)

(To be submitted online. In case of exigencies on paper in the specified format below)

Name of industrial establishment or undertaking or employer.....................................
Labour Identification Number.........................................................................................

Dated.................

( Note: The application to the Central Government shall be served as indicated below:
Lay-off : at least 15 days before the intended Lay-off
Continuation of Lay-off – at least 15 days before the expiry of earlier lay-off
Retrenchment – at least 60 days before the intended date of retrenchment
Closure – at least 90 days before the intended date of closure)

To,

The Secretary to the Government of India,
Ministry of Labour and Employment
New Delhi

1.     *(Lay-off) (a). Under section 78(2) of the Industrial Relations Code, 2020 (35 of 2020), I*/we* hereby apply for
       “permission to lay-off ……….workers** out of total of …….. workers** employed in my*/our* establishment
       (details to be given in Annexure-I) with effect from ……….. (DD/MM/YYYY) for the reasons explained in Annexure-
       I..

                                                                               or

       *(Continuation of lay-off) (b) Under section 78(3) of the Industrial Relations Code, 2020 (35 of 2020), I*/we*
       hereby apply for permission to continue the Lay-off .........workers** out of total of …….. laid off workers** in
       my*/our* establishment (details to be given in Annexure-I) with effect from ……….. (DD/MM/YYYY) for the
       reasons explained in Annexure-I.

                                                                                    or

       *(Retrenchment) (c) Under section 79(2) of the Industrial Relations Code, 2020 (35 of 2020), I*/we* hereby apply
       for permission for intended retrenchment of................. workers out of total of …….. workers** employed in
       my*/our* establishment (details to be given in Annexure-I) with effect from ……….. (DD/MM/YYYY) for the
       reasons explained in Annexure-I.

                                                                                    or

       *(Closure) (d) Under section 80(1) of the Industrial Relations Code, 2020 (35 of 2020), I / we* hereby inform you
       that I*/we* intended to close down the undertaking........................................ (name of the industrial establishment
       or undertaking or employer) (details to be given in Annexure-I) with effect from............. (DD/MM/YYYY) for the
       reasons explained in Annexure-I.. The number of workers whose services would be terminated on account of the
       closure of the undertaking is................. (number of workers).

* (Lay-off/Continuation of Lay-off) The worker(s) concerned were given on .................. (DD/MM/YYYY) notice in
writing as required under section 78(2)*/ section 78(3)* of the Industrial Relations Code, 2020 (35 of 2020).

                                                                                    or

      *(Retrenchment/ Closure) The worker(s) concerned were given on……... (DD/MM/YYYY) three month’s notice
      in writing as required under section 79*/ section 80* of the Industrial Relations Code, 2020 (35 of 2020).

                                                                or

      *(Retrenchment/ Closure) The worker(s) have been given on……... (DD/MM/YYYY) three month’s pay in lieu of
      notice as required under section 79*/ section 80* of the Industrial Relations Code, 2020 (35 of 2020).

2.       The details of affected worker(s) is at Annexure II.
3.      (Retrenchment) I*/we* hereby declare that the workers concerned will be retrenched in compliance to the
        section 71 and section 72 of the Industrial Relations Code, 2020 (35 of 2020).
4.   *I/We* hereby declare that the worker(s) concerned have been*/will be* paid all the dues and compensation due
     to them under section 67, read with section 78(10)*/ section 79* / section 80* of the Industrial Relations Code,
     2020 (35 of 2020) before or on the expiry of the notice period.
                                                                or
   *I/We hereby state that currently Insolvency proceedings are on in respect of the said Industrial
     Establishment/Undertaking/Employer, and that I*/we* will pay all the dues along with the compensation due to
     them under concerned laws.

5.    I/ we* hereby declare that no court case is pending before any Court in the matter, and if yes, the details thereof
       have been annexed herewith.

6.     I/ we hereby declare that the above information given by me/ us* in this notice and enclosures is/ are* true, I/ we
       am/ are solely responsible for its accuracy and no facts/ materials has been suppressed in the matter.

      The permission sought for may please be granted.

                                                                                                         Yours faithfully,

                                                                        (Name of employer/ ***authorised representative
                                                                                                             with seal)
 (* Strike off which is not applicable.)
 (** Indicate number in figures and word both)
(***Copy of authorisation letter issued by the employer shall be enclosed)

                                                     ANNEXURE I
                             (Please give replies against each item)

 1.      Name of the undertaking with complete postal address, email, mobile and land
         line.

 2.      Status of undertaking—
         (i) Whether Central public sector/State public sector/ like other,

         (ii) Whether a private limited company/ partnership firm/ partnership firm

         (ii) Whether the undertaking is licensed/registered and if so, name of licensing/
         registration authority and licence/registration certificate numbers.

 3.      (a) Corporate Identification Number

         (b) Goods and Service Tax Identification Number (GSTIN)

      4.    (i) Annual production, item wise for preceding three years-
           (ii) Production figures, month-wise, for the preceding twelve months,

      5.   Audit report of the legal entity that own the establishment/ undertaking including To be annexed
           Balance sheets, profit and loss accounts for the last three years.

      6.   Names of the inter-connected companies or companies under the same
           management.

      7.   Reasons for the intended lay-off/continuation of lay-off/ retrenchment/closure

      8.   Details of lay-off/ retrenchment resorted to in the last three years including the
           periods of such lay-offs/ retrenchment the number of workers involved in each
           such lay-off/ Retrenchment / continuation of lay off

      9.   Any other relevant details which have bearing on lay-off/ continuation of lay
           off/ retrenchment/ closure.

                                                      ANNEXURE II
                                                (Details of affected workers)

Sl.         UAN/         Name of worker     Category ( highly     Date from which in        Wage as on        Remark
No         CMPFO                             skilled / skilled/   service in/with the         date of
                                              semi-skilled /      said establishment        application
                                                unskilled)           /undertaking/
                                                                       employer