BEFORE THE HON'BLE LABOUR-CUM-CONCILIATION

OFFICER OF ……………………………….[CD1] 

 

Reference No: _____________ of 20…………...

 

………………………………………………………………………………………….………………Workmen 

Versus

 

………………………………………………….……………………………………………………….Employer/Respondent 

 

In the matter of -ABOVE MENTIONED- I/we hereby authorize  Shri __________________ to represent me in the above matter. 

 

Dated this ______. 

 

Signatures of person nominating the representative 

 

Address : 

 

Accepted 

 

Signatures of Representatives 

 

Address: 

 

________________________ 

 [CD1]BEFORE THE HON'BLE LABOUR-CUM-CONCILIATION OFFICER OF ……………………………….