FORM C [See Rule 5] Form of 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 Rule 3/subrule(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...... Legal practitioner Date...... Official of a registered Trade Union.
