APPLICATION FORMAT To, The Labour Commissioner and Director of Employment & Training, Andaman & Nicobar Administration, Port Blair. Sub:-Non- Payment of Wages Complaint application there of - Reg. 1. The applicant is a........person employed/sub Contractor) in the establishment of...............situated at..... ........as a ...........for the period from.... ...........to.................... 2. The address of the applicant for the service of the notice and process is... ............................... 3. Shri. ..........................is the responsible ................(employer/contractor) for the payment of wages under section 3 of the payment of wages Act, 1936 and his address for the service of all notice under process is .................. 4. (i) The applicant's wages @ Rs...........Per........ . (month/day) have been paid for the following wages period (s). Wages Period Amount From................to............Rs. From................to............Rs. Total Rs:- (ii) The applicant received Rs...........as an advance and Rs...............have not been paid to the applicant till date. 5. The applicant estimates the value of the relief sought by him at a sum of Rs.... ................................. The applicant therefore prays that necessary action in this regard may kingly be initiated. (Signature of the Applicant)
