FORM K3
RECOVERY OF DUES
[Rule 62(2)]

Application under sub-section (2) of section 33C of the Industrial Disputes Act, 1947
Before the Central Government Labour Court at __________________________
                                                           Between
                                              ______________________ Applicant (s)
                                                          And
                                             ______________________ Employer
The petitioner, ____________________ a workman of ___________________ M/s, ___________________ of _______________ The petitioners undersigned, workmen of _________________ is/are entitled to receive from the said M/s _____________________ the money/benefits mentioned in the statement hereto annexed.
It is prayed that the Court be pleased to determine the amount/amounts due to the petitioner (s).
 Signature or thumb impression (s) of the applicant (s)
________________________                                                                                         Address(es)______________
____________
1.
2.
3.
4.
Station _____________
Date _______________
ANNEXURE
(Set out the details of the money due or the benefits accrued together with the case for their admissibility)