FORM QA
NOTICE FOR PERMISSION OF CLOSURE UNDER SECTION 25-O (1)
(Rule 76C(1))
(To be submitted in triplicate)

To
The Secretary to the Government of India,
Ministry of Labour, New Delhi.
Sir,
1. Under section 25C of the Industrial Disputes Act, 1947, I / we hereby inform you that I / we propose to close down the undertaking specified below of (name of the industrial establishment).
(Give details of the undertaking)
_________________________________________________________________
w.e.f.______________ for the reasons explained in the Annexure.
2. The number of workmen whose services will be terminated on account of the closure of the undertaking is _______________ (number of workmen).
3. Permission is solicited for the proposed closure.
4. I / We hereby declare that in the event of approval for the closure being granted , every workman in the undertaking to whom 30[sub-section (8) of the said section 25-O applies shall be paid compensation as specified in that section.]
 Yours faithfully,
Date ________________
 Signature _______________
30. Substituted by GSR 761, dated 2nd.August, 1985.
ANNEXURE
(Give details against each item)
1. Name of the industrial establishment with complete postal address, including telegraphic address and telephone number :
2. Status of undertaking :
(i) Whether Central public sector / State public sector / foreign majority company / joint sector, etc.
(ii) If belongs to large industrial house, please indicate the controlling group; and if a foreign majority company, indicate the extent of foreign holdings.
(iii) Whether the undertaking is licensed / registered and if so, name of licensing / registration authority and licence / registration certificate numbers.
3. The total number and categories of workmen affected by the proposed closure, along with the addresses of the workmen and the details of wages drawn by them
4. Items of manufacture and scheduled industry / industries under which they fall :
5. Details relating to installed capacity, licensed capacity and utilised capacity :
6.        (i) Annual production, item-wise for preceding three years :
(ii) Production figures, month-wise, for the preceding twelve months :
7. Work in progress : Item-wise and value-wise.
8. Any arrangement regarding off-loading or sub-contracting of products or any component thereof:
9. Details of persons or the organisations to whom the job / jobs is / are being entrusted –relationship / interest of the persons/organisations with the director / directors or the officer / officers of the company:
10. Position of the order book : Item-wise and value-wise for a period of six months, and one year next following, and for the period after the expiry of the said one year:
11. Number of working days in a week with the number of shifts per day and the strength of workmen per each shift :
12. Balance sheets, profit and loss accounts and audit reports for the last three years.
13. Financial position of the company.
14.
(i) Names of the inter-connected companies or companies under the same management:
(ii) Details about inter corporate investments and changes during the last one year:
(iii) Interest of any of the directors / officer of the under taking producing same or similar type of product:
15. Percentage of wages of workmen to the total cost of production:
16. Administrative, general and selling cost in absolute terms per year in the last three years and percentage thereof to the total cost:
17. Inventory position : Item-wise and value-wise for the preceding twelve months (Inventories to be shown in respect of finished products, components and raw-materials to be shown separately item-wise and value-wise) :
18. Selling arrangement for the last three years and any change in the selling arrangement in preceding twelve months :
19. Full details of the interests of the directors and officers of the company in the organisations / persons involved in selling products of the undertaking:
20. Buying arrangements for raw materials and components :
21. Interests of the directors and officers with the organisations / persons involved in buying raw materials and components for the undertaking:
22. Annual sales figures for the last three years and month-wise sales figures for the preceding twelve months, both item-wise and value-wise :
23. Reasons for the proposed closure :
24. Any specific attempts made so far to avoid the proposed closure :
25. Any other relevant factors with details thereof :