FORM I-A

The Industrial Employment (Standing Orders) Act, 1946

Sections 3, 10, 15(2) (a)

Dated ...............20................
To,
The Deputy Labour Commissioner & Certifying Officer
Department of Labour
Government of Karnataka

Sir,
Under the provisions of sections 3,10,15(2) (a) of the Industrial Employment (Standing
Orders) Act, 1946, I enclose five copies of the draft modifications proposed by me for
adoptions in
(Name) ...................................................................................
(Place) ....................................................................... (Postal
address).................................................................................... and industrial establishments
owned/controlled by me/in which I am a workman with the request that these orders may
be certified under the terms of the Act.
I also enclose a statement giving the particulars prescribed in Rule 5 of the Karnataka
Industrial Employment (Standing Orders) Rules, 1961 (applicable only in the case of an
employer)

I am , etc,
(Signature)
Employer/Manager/Workman