FORM 9 Application for review filed under sub-section (1) of section 7B of the Employees’ Provident Funds and Miscellaneous Provisions Act, 1952 Paragraph 79A For use in Commissioner’s Office | | | Date of filing or | | | Date of receipt by post | | | Registration No. | | | | Signature | | | for Commissioner | |
1.Name of the applicant | ……........................................................... | 2.Designation of the applicant or his relationship with the factory/establishment (whether owner/partner/director/manager, etc., to be indicated) | ……............................................................ | 3.Name and complete address of the factory/establishment | …….......................................................... | 4. Address of the employer for service of notice/summons. | ................................................................... | 5.Particulars of the order against which the review application is filed:— | ................................................................... | (i) Order No. | ................................................................... | (ii) Date of order | ................................................................... | (iii) Passed by | ................................................................... | (iv) Subject in brief | ................................................................... | 6. Main ground(s) on which the application for review has been made and the relief(s) sought. (If necessary, attach a duly signed statement with copies of the documents relied upon marked as A-1, A-2, A-3 and so on.) | ...........................................………............ |
Verification I................................ (Name of the applicant) s/o, d/o, w/o...................................... age...................... working as.......... resident of..........................do hereby verify that the contents of particulars given at Sl. Nos. 1 to 6 above are true to the best of my knowledge and belief and I have not suppressed any material fact. I further declare that:— (i) I am filing the application within 45 days from the date of the original order. (ii) I have not preferred any appeal against the original order under the Employees’ Provident Funds and Miscellaneous Provisions Act, 1952. (iii) I am filing with this application, the original document authorising me to represent the aggrieved person (applicable only in cases where the application is filed by agent, advocate or other representative). Place and date |
