FORM Q

[See sub-rule (2) of Rule 34]

Serial No…………………..

Application for Copies

(To be preserved for one year)

To

The Authority/Officer under the West Bengal Shops & Establishments Act, 1963, for
recovery of wages.

[Here insert the address]

Sir,

I require a certified/uncertified copy of the documents mentioned below, which may

be supplied.

Date………………….. ……………………………..

Signature of the applicant

Description of document of which copy is required

Description No. and year of the case of which it forms part, names of the parties,
etc.

Report of clerk-in-charge of the records

Folios and Court-fees required

Date………………….. ……………………………..

Signature of the clerk-in-charge

Received copy and unsued folios and stamps

Date………………….. ……………………………..

Signature of the Applicant

……………………………………………………………………………………………………………………………….
 (Counterfoil of Application for copies)

Received application for copies being Serial No. …………………………………..

Date …………………………………..

Folios and Court-fees required

Date………………….. ……………………………..

Signature of the clerk-in-charge