Station Date. (Here set out the details of the money due or the benefits accrues together with the case for their admissibility) Signature or thumb impression (s) (Address) of the applicant. ANNEXURE 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)Application for Settlement of Disputes under Industrial Dispute Act, 1947 (See Rule 69 (2) 198E ORISSA INDUSTRIAL DISPUTES RULES, 1959 (F.T- 3) FORM T-3 Government of OrissaLabour & Employment DepartmentNote:
