LABOUR GRATITUDE CASE





BEFORE THE LABOUR OFFICER CUM CONTROLLER GRATUITY UNDER THE PAYMENT OF GRATUITY ACT, 1972 COIMBATORE TN



Application No.: _____



BETWEEN

Applicant/Employee

AND



Respondent/Employer

Application under Rule 10 (i) of the Payment of Gratuity (Central) Rules 1972



Respectfully Sheweth:

1. The applicant is an employee of the above-mentioned employer, and is entitled to payment of gratuity under Section 4 of the Payment of Gratuity Act, 1972, on account of his own superannuation/retirement/retrenchment/resignation on _______ after completion of _______ years of continuous service wef _______ to _______ .

2. That the applicant submitted an application under rule __ of the Payment of Gratuity Act, 1972 on the employer but the above-mentioned employer refused to entertain the same/issued a notice dated the ________ under clause ______ of sub-rule _______ offering an amount of gratuity which is less than my due/issued a notice dated the _______ under clause _______ of sub-rule _______ of rule _______ rejecting my eligibility of payment of gratuity. The duplicate copy of the said notice is enclosed.

3. The applicant submits that there is a dispute on the matter as under:-

(a) _______________

4. The applicant furnishes the necessary particulars in the Annexure hereto and prays that the Controlling Authority may be pleased to determine the amount of gratuity payable to the petitioner and direct the above-mentioned employer to pay the same to the petitioner.

5. The applicant declares that the particulars furnished in the Annexure hereto are true and correct to the best of my knowledge and belief.

Dated: _____

Applicant

Annexure

1. Name in full of applicant with full address.

2. Basis of claim:

3. Name and address in full of the employee :

4. Marital status of the employee:

5. Name and address in full of the employer :

6. Department/Branch/Section where the employee was employed (If known) :

7. Post held by the employee with Ticket or Serial No., if any [if known]. :

8. Date of appointment of the employee [if known].

9. Date and cause of termination of service of the employee.

10. Total period of service by the employee :

11. Wages last drawn by the employee.

12. If the employee is dead, date and cause thereof.

13. Evidence/witness in support of death of the employee.

14. If a nominee, No. and date of recording of nomination with the employer.

15. Evidence/witness in support of being a legal heir, if a legal heir.

16. Total gratuity payable to the employee [If known]:

17. Percentage of gratuity payable to the applicant as a nominee/legal heir:

18. Amount of gratuity claimed by the applicant:

Applicant

Place ______

Dated: _______