FORM K
DISCHARGE, DISMISSAL, ETC.PENDING PROCEEDINGS
[Rule 60(2)]

Before __________________________ (Mention Conciliation Officer/Board/Labour Court/Tribunal or National Tribunal)
Application under sub-section (2) of section 33 of Industrial Disputes Act, 1947, in the matter of Ref. No _____________________
                                                           _____________ Applicant
                                                          Address ________________
                                                                           Versus
 ________________ Opposite Party (ies)
                                                        Address_______________
The above-mentioned applicant begs to state as follows:
(Set out the relevant facts and circumstances of the case)
The workman/workmen discharged/dismissed under cl.(b) of sub-section (2) of section 33 has/have paid wages for one month.
The applicant prays that the Conciliation Officer/Board/Labour Court/Tribunal/National Tribunal may be pleased to approve of the action taken namely :
[(Mention the action taken under clause (a) or clause (b) of sub-section (2) of section 33)]
Signature of the applicant
Verification______________________________________________________________
______________________________________________________________
Signature of the person verifying
Dated this _____________________ day of _____________ 19 ___________
Date (on which the verification was signed) ______________________________
Place (at which the verification was signed) _______________________________