FORM 'T'

[See rule 19]



Application for recovery of gratuity



Before the Controlling Authority under the Payment of Gratuity Act, 1972.



Application No ……….. Date ……………..



Between ……………………………………



[Name in full of the applicant with address]

And

[Name in full of the employer with full address]



The applicant is an employee of the above-mentioned employer/a nominee of late …………. an employee of the above mentioned employer/a legal heir of late …………..., an employee of the

above mentioned employer, and you were pleased to direct the said employer in your notice dated the ……………. under rule …………….. of the Payment of Gratuity (Central) Rules, 1972 for payment of a sum of Rs ……….. as gratuity payable under the Payment of Gratuity Act, 1972.



2. The applicant submits that the said employer failed to pay the said amount of gratuity to me as directed by you although I approached him for payment.



3. The applicant therefore prays that a certificate may be issued under section ……………… of

the said Act for the recovery of the said sum of Rs …………………. due to me as gratuity in terms

of your direction.



Place Signature/Thumb impression

Date of the applicant