Rule Form X Form X
- Chapter
- Annexures · Forms and Appendices
- Text as on
- As notified 08 May 2026
FORM- X [See rule 24]
(APPLICATION UNDER SECTION 59(2) OF THE INDUSTRIAL RELATIONS CODEDefined in rule 2(a): Code means the Industrial Relations Code, 2020 (35 of 2020), 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).