Form of authority in favour of legal practitioner or any official of a registered Trade Union. I/We hereby authorize Shri/Shrimati/Kumari______________ a legal practitioner/an official of__________________ which is a registered Trade Union to appear ___________________ and act on my/our behalf, under sub-rule(3) of rule3/sub-rule(3)
of rule 4 in respect of the Complaint/claim against________________ (mention name of
employer) on account of _________________ (mention violation of the Act). Signature(s)/thumb impression(s)
of the worker(s).
Station _____________________
Date _______________________
Witness
(1)
(2)
(3) I accept the authorization.
Station _____________________
Date _______________________
Legal practitioner/
Official of a registered Trade Union
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Strike out whichever is inapplicable.
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