198 E ORISSA INDUSTRIAL DISPUTES RULES,1959 (F.T_3)
Rule 69 (2)
under sub section(2) of section 33-C of the Industrial Dispute Act,1947.
Before the Labour Court at_____ Between (1) Name of the applicant(s)_______ (2) Name of the employer _________. The petitioner ______ a workman of ____ the petitioner's undersigned workmen of Messrs________ of is/are entitled to receive from the said Messrs______ the money/benefits mentioned. In the statement amounts due to the petitioned (s)
It is prayed that the Court be pleased to determine the amounts due to the petitioner (s).
Station______ Signature or thumb impression (s) (Address) of the applicant.
(Here set out the details of the money due or the benefits accrues together with the case for their admissibility)