The Social Security (Central) Rules, 2026

Rule Form I Form I

Chapter: Annexures · Forms and Appendices
Text as on: As notified 08 May 2026

FORM- I [See rule 13 (2)(a)]

APPEAL UNDER SECTION 23 OF THE CODE ON SOCIAL SECURITY, 2020

Title of the case:

Serial No. APPEAL Page No.

1. INDEX 2.

3. Description of documents relied 4.

Signature of the Applicant

For use in Tribunal's office Date of filing (or) Date of receipt by post Registration No.

Signature of Registrar

IN THE CENTRAL GOVERNMENT INDUSTRIALTRIBUNAL

BETWEEN APPELLANT A.B.

Vs.

C.D. RESPONDENT

DETAILS OF APPEAL

1. Particulars of the Appellant:

i. Name of the appellant

ii. Office address

iii. Address for service ofnotices

2. Particulars of the Respondent:

i. Name of therespondent

ii. Office address

iii. Address for service ofnotices

3. Particulars of the order/notification against which appeal is made.- The appeal is against

the followingorder/notification

i. Order/notification No. with reference to Annexure

ii. Date iii. Passed by iv. Subject inbrief

4. Jurisdiction of the Tribunal.- The appellant declares that the subject of the matter against which he wants redressal is within the jurisdiction of theTribunal.

5. Limitation. --

The appellant further declares that the appeal is within the limitation specified in section 126 of the Code on Social Security, 2020 (36 of 2020).

6. Facts of the case.- The facts of the case are given below:

(Give here a concise statement of facts in a chronological order, each paragraph containing as nearly as possible a separate issue, fact or otherwise)

7. Details of remedies exhausted. --

The appellant declares that he has availed of all the remedies available to him under the Code.

(Give here chronologically the details of representations made and the outcome of such representation with reference to the Annexure numbers).

8. Matters not previously filed or pending with any other Court. --

The appellant further declares that he had not previously filed any appeal, writ petition or suit regarding the matters in respects of which this appeal has been made, before any court of law or any other authority or any other bench of the Tribunal nor any such appeal, writ petition or suit is pending before any ofthem.

In case the appellant has previously filed any appeal, writ petition or suit, the stage at which it is pending and if decided, the gist of the decision should be given with reference to the Annexure.

9. Relief(s) sought. --

In view of the facts mentioned in para 6 above, the appellant prays for the following relief(s):--

[Specify below the relief(s) sought explaining the ground for relief(s) and the legal provisions (if any) relied upon].

10. Interim order, if any, prayed for. --

Pending final decision on the appeal the applicant seeks issue of the following interim order--

(Give here the nature of the interim order prayed for with reasons)

11. In the event of appeal being sent by speed post (with registration), it may be stated whether the appellant desires to have oral hearing at the admission stage and if so, he shall attach a self-addressed Post Card, Inland Letter, at which intimation regarding the date of hearing could be sent tohim.

12. Particulars of Bank Draft or Postal order in respect of the Appeal Fee:

13. Name of the Bank on which drawn

14. Demand Draft No. (OR)

15. Details of online fund transfer

16. List ofenclosures

1. 2. 3. 4. 5. 6.

VERIFICATION

I, .............................. (Name of the Appellant) S/O, D/O, W/O ....................... Age............. working as ...........in the office of ...................... resident of ............. do hereby verify that the contents of paras .......... to................ are true to my personal knowledge and paras ........ to.......... believed to be true on legal advice and that I have not suppressed any material fact.

Signature of the Appellant

Date: Place:

To The Registrar

FORM- I
[See rule 13 (2)(a)]

APPEAL UNDER SECTION 23 OF THE CODE ON SOCIAL SECURITY, 2020

Title of the case:

Serial No.                                APPEAL                Page No.
1.                                         INDEX
2.
3.                  Description of documents relied
4.

Signature of the Applicant

For use in Tribunal's office
Date of filing (or) Date of receipt by post Registration
No.

Signature of Registrar

IN THE CENTRAL GOVERNMENT INDUSTRIALTRIBUNAL

BETWEEN                             APPELLANT
A.B.

Vs.

C.D.                                RESPONDENT

DETAILS OF APPEAL

1. Particulars of the Appellant:

i. Name of the appellant

ii. Office address

iii. Address for service ofnotices

2. Particulars of the Respondent:

i. Name of therespondent

ii. Office address

iii. Address for service ofnotices

3. Particulars of the order/notification against which appeal is made.- The appeal is against

the followingorder/notification

i. Order/notification No.           with reference to Annexure

ii. Date
iii. Passed by
iv. Subject inbrief
4. Jurisdiction of the Tribunal.- The appellant declares that the subject of the matter against
which he wants redressal is within the jurisdiction of theTribunal.
5. Limitation. --The appellant further declares that the appeal is within the limitation specified
in section 126 of the Code on Social Security, 2020 (36 of 2020).
6. Facts of the case.- The facts of the case are given below:

(Give here a concise statement of facts in a chronological order, each paragraph
containing as nearly as possible a separate issue, fact or otherwise)

7. Details of remedies exhausted. --The appellant declares that he has availed of all the
remedies available to him under the Code.

(Give here chronologically the details of representations made and the outcome of
such representation with reference to the Annexure numbers).

8. Matters not previously filed or pending with any other Court. --The appellant further
declares that he had not previously filed any appeal, writ petition or suit regarding the matters
in respects of which this appeal has been made, before any court of law or any other authority
or any other bench of the Tribunal nor any such appeal, writ petition or suit is pending before
any ofthem.

In case the appellant has previously filed any appeal, writ petition or suit, the
stage at which it is pending and if decided, the gist of the decision should be given
with reference to the Annexure.

9. Relief(s) sought. --In view of the facts mentioned in para 6 above, the appellant prays for the
following relief(s):--

[Specify below the relief(s) sought explaining the ground for relief(s) and the legal
provisions (if any) relied upon].

10. Interim order, if any, prayed for. --Pending final decision on the appeal the applicant seeks
issue of the following interim order--

(Give here the nature of the interim order prayed for with reasons)

11. In the event of appeal being sent by speed post (with registration), it may be stated whether
the appellant desires to have oral hearing at the admission stage and if so, he shall attach a
self-addressed Post Card, Inland Letter, at which intimation regarding the date of hearing
could be sent tohim.

12. Particulars of Bank Draft or Postal order in respect of the Appeal Fee:

13. Name of the Bank on which drawn
14. Demand Draft No. (OR)
15. Details of online fund transfer
16. List ofenclosures

1.
2.
3.
4.
5.
6.

VERIFICATION

I, .............................. (Name of the Appellant) S/O, D/O, W/O .......................
Age............. working as ...........in the office of ...................... resident of ............. do
hereby verify that the contents of paras .......... to................ are true to my personal knowledge
and paras ........ to.......... believed to be true on legal advice and that I have not suppressed any
material fact.

Signature of the Appellant

Date:
Place:

To
The Registrar