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The Industrial Dispute Act 1947      BEFORE THE HON’BLE PRESIDING OFFICER LABOUR COURT OF AT ……………………….   Application No:______ of 20………   ……………………………………………………………Applicant/Workman  Versus

SICKNESS /TEMPORARY DISABLEMENT BENEFIT CLAIM FOR BENEFIT    1……………………………………………… s/w/d of …………………………………. Insurance No. ………………………………. hereby say that I was certified sick/temporarily disabled from ……….

SICKNESS /TEMPORARY DISABLEMENT BENEFIT CLAIM FOR BENEFIT   1………………………… s/w/d of ……….Insurance No. …………………. hereby say that I was certified sick/temporarily disabled from ………. a.m./p.m.