198 E ORISSA INDUSTRIAL DISPUTES RULES, 1959 (F.T_3) FORM T-3 (See Rule 69 (2) Application under sub section (2) of section 33-C of the Industrial Dispute Act, 1947. Before the Labour Court at_____ Between (1) Name of the applicant(s)_______ (2) Name of the employer _________. The petitioner ______ a workman of ____ the petitioner's undersigned workmen of Messrs________ of is/are entitled to receive from the said Messrs______ the money/benefits mentioned. In the statement amounts due to the petitioned (s) It is prayed that the Court be pleased to determine the amounts due to the petitioner (s). Station______ Signature or thumb impression (s) (Address) of the applicant. Date.___________ ANNEXURE (Here set out the details of the money due or the benefits accrues together with the case for their admissibility)
