FORM ‘Q’
[SEE SUB-RULE (1) OF RULE 19]
PARTICULARS OF APPLICATION UNDER SECTION (P.37)

1.  Serial No.
2.  Date of the application.
3.  Name and address of the applicant.
4.  Name and address of the employer.
5.  Amount of gratuity claimed.
6.  Dates of hearing.
7.  Findings with date.
8.  Amount awarded.
9.  Cost, if any, awarded.
10.  Date of notice issued for payment of gratuity.
11.  Date of appeal, if any.
12.  Decision of the appellate authority.
13.  Date of Issue of Final Notice for payment of gratuity.
14.  Date of Payment of Gratuity by Employer with mode of payment.
15.  Date of Receipt of application for recovery of Gratuity.
16.  Date of Issue of Recovery Certificate.
17.  Date of Recovery.
18.  Other remarks.
19.  Signed.
20.  Date.