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Notice of lay-off and lay-off compensation computation

Factory / Mine / Plantation / Other

Total worker-days, preceding calendar month

Working days in that month

Seasonal or intermittent / Neither

Average workers, preceding twelve months (1)

Shortage of coal / Shortage of power / Shortage of raw materials / Accumulation of stocks / Breakdown of machinery / Natural calamity / Other connected reason (1)

Name of the establishment

Address of the establishment

Registration or licence number

Reference number

DD.MM.YYYY (1)

Department or section affected

State the cause in plain words, e.g. breakdown of the 1,200-tonne press on line 2 on 12.10.2026; the replacement crankshaft has been ordered from the manufacturer and is expected by 20.10.2026

Time (1)

DD.MM.YYYY (2)

Shortage of coal / shortage of power / shortage of raw materials / accumulation of stocks / breakdown of machinery / natural calamity / other connected reason (2)

DD.MM.YYYY (3)

Seven (1)

Time office / main gate

Time of reporting

The usual wage day / every Saturday

Date of the agreement under the first proviso

Describe the alternative work, place, shift and wages offered, and to whom, or state that none is available at present

Name and designation of the contact person

Time (2)

DD.MM.YYYY (4)

SMS / e-mail / messaging application

Telephone number

Hours

Worker 1 name

Worker 1 code

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (1)

Worker 1 department

Yes / No (1)

Worker 2 name

Worker 2 code

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (2)

Worker 2 department

Yes / No (2)

Worker 3 name

Worker 3 code

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (3)

Worker 3 department

Yes / No (3)

Worker 4 name

Worker 4 code

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (4)

Worker 4 department

Yes / No (4)

Worker 5 name

Worker 5 code

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (5)

Worker 5 department

Yes / No (5)

Name of the authorised signatory

Designation of the authorised signatory

DD.MM.YYYY (5)

Place of display

Time and date of display

SMS / e-mail / messaging application / hand delivery

Name of the person who displayed the notice

DD.MM.YYYY (6)

Labour Commissioner / Deputy Chief Labour Commissioner (Central) / authority notified by the appropriate Government

Address of the authority

Jurisdiction of the Conciliation Officer

DD.MM.YYYY (7)

Factory / mine / plantation

Nature of the industry

Average workers in the preceding calendar month

Average workers, preceding twelve months (2)

Number of workers laid off

Time (3)

DD.MM.YYYY (8)

End on DD.MM.YYYY / continue until the cause is removed

DD.MM.YYYY (9)

Describe the alternative work offered, or state that none is available at present

Seven (2)

Document evidencing the cause, e.g. breakdown report, supplier's letter or power utility's notice

City

DD.MM.YYYY (10)

The workers whose names and signatures appear below / Name of the negotiating union, the negotiating union of the workers of the establishment under section 14 of the Code, acting through its office bearers named below

Describe the recurring causes, e.g. seasonal shortage of raw material and grid power cuts

DD.MM.YYYY (11)

DD.MM.YYYY (12)

Two

Seven (3)

Name of the first signatory for the workers

Name of the second signatory for the workers

DD.MM.YYYY (13)

Muster entry 1 worker

Muster entry 1 time

Muster entry 1 signature

Yes / No / Second half only (1)

Full day / Half day / Not laid off (1)

Muster entry 1 alternative work

Muster entry 1 remarks

DD.MM.YYYY (14)

Muster entry 2 worker

Muster entry 2 time

Muster entry 2 signature

Yes / No / Second half only (2)

Full day / Half day / Not laid off (2)

Muster entry 2 alternative work

Muster entry 2 remarks

DD.MM.YYYY (15)

Muster entry 3 worker

Muster entry 3 time

Muster entry 3 signature

Yes / No / Second half only (3)

Full day / Half day / Not laid off (3)

Muster entry 3 alternative work

Muster entry 3 remarks

DD.MM.YYYY (16)

Muster entry 4 worker

Muster entry 4 time

Muster entry 4 signature

Yes / No / Second half only (4)

Full day / Half day / Not laid off (4)

Muster entry 4 alternative work

Muster entry 4 remarks

DD.MM.YYYY (17)

DD.MM.YYYY (18)

Weekly holidays in the spell

Paid holidays in the spell

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (6)

Yes / No (6)

Yes / No (7)

Yes / No (8)

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (7)

Yes / No (9)

Yes / No (10)

Yes / No (11)

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (8)

Yes / No (12)

Yes / No (13)

Yes / No (14)

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (9)

Yes / No (15)

Yes / No (16)

Yes / No (17)

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (10)

Yes / No (18)

Yes / No (19)

Yes / No (20)

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (11)

Yes / No (21)

Yes / No (22)

Yes / No (23)

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (12)

Yes / No (24)

Yes / No (25)

Yes / No (26)

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (13)

Yes / No (27)

Yes / No (28)

Yes / No (29)

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (14)

Yes / No (30)

Yes / No (31)

Yes / No (32)

Permanent / Probationer / Fixed-term / Temporary / Badli / Casual (15)

Yes / No (33)

Yes / No (34)

Yes / No (35)

Name of the preparer

Designation of the preparer

DD.MM.YYYY (19)

Name of the approver

Designation of the approver

DD.MM.YYYY (20)

Application for prior permission for lay-off, retrenchment or closure, establishments with 300 or more workers

Name of the company

CIN of the company

Registered office address

DD.MM.YYYY (1)

Time

Place of the meeting

DD.MM.YYYY (2)

Name and designation of the officer who placed the note

Undertaking, unit or department concerned

Address of the establishment

Factory / mine / plantation

Average workers per working day, preceding twelve months

DD.MM.YYYY (3)

State Government of State / Central Government

Lay-off of Number workers / retrenchment of Number workers / closure of the undertaking

Intended date of the action

Estimated cost in Rs

78 / 79 / 80

Industrial Relations (Central) Rules 2026 / rules made by the State Government of State under the Code

Name of the authorised signatory

Designation of the authorised signatory

The workers concerned / the representatives of the workers

Pay lay-off compensation under section 67 of the Code / serve on each worker three months' notice in writing indicating the reasons for retrenchment or pay wages in lieu of notice, pay at the time of retrenchment compensation of fifteen days' average pay for every completed year of continuous service or any part in excess of six months, and contribute fifteen days' wages last drawn of each retrenched worker to the worker re-skilling fund under section 83 / pay each worker compensation of fifteen days' average pay for every completed year of continuous service or any part in excess of six months

Name of the director

DIN of the director

DD.MM.YYYY (4)

Place of signing

Name of the establishment

Reference number

DD.MM.YYYY (5)

Secretary, Department of Labour, Government of State / authority specified by the appropriate Government under Chapter X

Address of the authority

Lay-off / retrenchment / closure

In Form-XIV of the Industrial Relations (Central) Rules 2026 / in the form prescribed by the rules of the State Government / in the content of Form-XIV, the State Government not having prescribed a form at the date of this letter

At least fifteen days before the intended lay-off / at least sixty days before the intended retrenchment / at least ninety days before the intended closure

78(5) / 79(4) / 80(3)

Name of the contact person

Designation of the contact person

Telephone number

E-mail address

DD.MM.YYYY (6)

Registered office, CIN and PAN

Registration or licence number

Nature of the industry

Appropriate Government and basis

Persons employed by category

Unions and negotiating union

Standing orders applicable

Settlement, award or agreement in force

Expected duration of the lay-off

Number and categories of workers affected

Position under section 71

Notice under section 79(1)(a)

Scope of the closure

Earlier applications and outcome

Set out the reasons in numbered paragraphs, specifically and with dates and figures: the cause, when it arose, what the establishment has done about it, why it cannot be overcome without the action, and why the number and categories of workers proposed are no more than the cause requires. Refer to the documents in Annexure 2.

Financial year 1

Revenue, year 1

Profit or loss, year 1

Net worth, year 1

Capacity, year 1

Workers, year 1

Financial year 2

Revenue, year 2

Profit or loss, year 2

Net worth, year 2

Capacity, year 2

Workers, year 2

Financial year 3

Revenue, year 3

Profit or loss, year 3

Net worth, year 3

Capacity, year 3

Workers, year 3

DD.MM.YYYY (7)

Revenue, current year

Profit or loss, current year

Net worth, current year

Capacity, current year

Workers, current year

State each alternative considered, for example redeployment to another unit, transfer within the same town or village, short-time working, a voluntary separation scheme, reduction of overtime and contract labour first, deferment of the action, and why each was not adopted or was adopted in part. State the contract labour engaged in the same work and what is proposed for it.

Estimated lay-off compensation

Estimated notice pay

Estimated retrenchment or closure compensation

Estimated re-skilling contribution

Estimated gratuity

Estimated wages and other dues

Estimated total dues

Held in the Company's bank account with Bank name / to be met from Source of funds

DD.MM.YYYY (8)

DD.MM.YYYY (9)

Month 1

Working days, month 1

Worker-days, month 1

Average, month 1

Month 2

Working days, month 2

Worker-days, month 2

Average, month 2

Month 3

Working days, month 3

Worker-days, month 3

Average, month 3

Month 4

Working days, month 4

Worker-days, month 4

Average, month 4

Month 5

Working days, month 5

Worker-days, month 5

Average, month 5

Month 6

Working days, month 6

Worker-days, month 6

Average, month 6

Month 7

Working days, month 7

Worker-days, month 7

Average, month 7

Month 8

Working days, month 8

Worker-days, month 8

Average, month 8

Month 9

Working days, month 9

Worker-days, month 9

Average, month 9

Month 10

Working days, month 10

Worker-days, month 10

Average, month 10

Month 11

Working days, month 11

Worker-days, month 11

Average, month 11

Month 12

Working days, month 12

Worker-days, month 12

Average, month 12

Total working days

Total worker-days

List the documents, for example audited financial statements for the last three years, the customer's letter terminating the contract dated DD.MM.YYYY, the supplier's force majeure notice, the pollution control board's closure direction, the plant engineer's report on the condition of the machinery, minutes of meetings with the union.

Affected worker 1

Affected worker 1 category

DD.MM.YYYY (10)

Affected worker 1 years

Affected worker 1 wages

Affected worker 1 compensation

Affected worker 2

Affected worker 2 category

DD.MM.YYYY (11)

Affected worker 2 years

Affected worker 2 wages

Affected worker 2 compensation

Affected worker 3

Affected worker 3 category

DD.MM.YYYY (12)

Affected worker 3 years

Affected worker 3 wages

Affected worker 3 compensation

DD.MM.YYYY (13)

Name of each worker concerned as listed in Annexure 3, or for a closure, the President and General Secretary of the negotiating union and of each registered trade union of the workers

DD.MM.YYYY (14)

Place for inspection

Hours

Place of display

Person served 1

By hand / Registered post / Speed post / E-mail (1)

Date and time of service 1

Acknowledgement 1

Person served 2

By hand / Registered post / Speed post / E-mail (2)

Date and time of service 2

Acknowledgement 2

Person served 3

By hand / Registered post / Speed post / E-mail (3)

Date and time of service 3

Acknowledgement 3

DD.MM.YYYY (15)

DD.MM.YYYY (16)

DD.MM.YYYY (17)

DD.MM.YYYY (18)

The acknowledgement number / the inward stamp / the portal acknowledgement

Date of deemed permission

Jurisdiction of the Conciliation Officer

78(7) / 79(6) / 80(5)

Order number

Date of the order

Date of receipt of the order

DD.MM.YYYY (19)

Refused / granted only in respect of Number workers / granted only for the period stated in it

Thirty

The order does not consider the documents at Annexure 2 to the application, in particular state the document, which establish the cause.

The order proceeds on a fact that is not correct, namely state it; the correct position, with the supporting record, is state it.

Circumstances have changed since the application: state the change, for example the loss of the remaining customer contract on DD.MM.YYYY.

The order gives no reasons, or reasons that do not address the genuineness and adequacy of the reasons stated by the employer and the interests of the workers, as section 78(4), 79(3) or 80(2) requires.

DD.MM.YYYY (20)

Name of the preparer

Designation of the preparer

DD.MM.YYYY (21)

Name of the reviewer

Designation of the reviewer

DD.MM.YYYY (22)

On the letterhead of the establishment. Work through Part A before anything is displayed: sections 67 to 69 apply only to a factory, mine or plantation employing fifty or more workers on average, and at three hundred or more workers no lay-off may begin without permission

Use this format where work cannot be given to workers on the muster roll for a reason within section 2(t) of the Industrial Relations Code 2020 (shortage of coal, power or raw materials, accumulation of stocks, breakdown of machinery, natural calamity or any other connected reason). It contains the applicability test (Part A), the notice displayed and served on the workers (Part B), the intimation to the appropriate Government (Part C), an agreement under the first proviso to section 67 (Part D), the muster roll kept during the lay-off (Part E) and the compensation computation (Part F). Where Chapter X applies, first obtain permission with the "Application for prior permission for lay-off, retrenchment or closure, establishments with 300 or more workers" in this pack. If the lay-off ends in retrenchment, use the "Notice of retrenchment", the "Notice of retrenchment or closure to the appropriate Government" and the "Board resolution approving a retrenchment and recording reasons for departure from LIFO" in the Exit and IR formats.

Part A. Applicability and pre-issue checks

Test	Entry	Result
Type of establishment (section 65)	[Factory / Mine / Plantation / Other]
Total worker-days employed in the preceding calendar month	[Total worker-days, preceding calendar month]
Working days in that calendar month	[Working days in that month]
Average workers per working day, preceding calendar month
Establishment of a seasonal character, or work performed only intermittently	[Seasonal or intermittent / Neither]
Average workers per working day, preceding twelve months	[Average workers, preceding twelve months]
Chapter X threshold (300, or the higher number notified by the appropriate Government)	300
Cause of the lay-off	[Shortage of coal / Shortage of power / Shortage of raw materials / Accumulation of stocks / Breakdown of machinery / Natural calamity / Other connected reason]
Overall position

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