FORM C Form of Application by an Inspector or Person Permitted By the Authority of Authorized to Act [See Sub- Section (2) of Section 15 and 16 of the Payment of Wages Act] In the Court of Authority appointed under the Payment of Wages Act, for ........ Area. Application No...... of 19....... Between A.B.C (designation)...........an inspector under the Permitted by the authority Payment of Wages Act or a person to act under Sub-Section (2) of Section 15].....................applicant. And X, Y, Z .........................the opposite party 1. X, Y, Z the opposite party is the person responsible under the Act for the payment of wages to the following 1[persons whose names and permanent addresses are given below]: (1) (2) (3) * * 2. His address for the service of all notices and processes is: 3. The wages of the said person(s) due in respect of the following wage -period (s) have not been paid/ have been subjected to the following illegal deductions: 4. The applicant estimates the value of the relief sought for the person(s) employed at the sum of Rs....... 5. The applicant prays that a direction may be issued under sub-Section (3) of Section 15 for: Page 93 of 151 (a) Payment of the delayed wages as estimated or such greater or lesser amount as the Authority may find to be due. Or Refund of the amount illegally deducted. (b) Compensation amounting to Rs....... The applicant certifies that the statement of facts contained in this application is, to the bets of his knowledge and belief, accurate. Signature Page 94 of 151
