Claim under Order No… dated ………. under section 220(4) of the Code- Regulation 14(3) -Inspection and Investigation

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..... oard of India (Inspection and Investigation) Regulations, 2017) Claim under Order No… dated ………. under section 220(4) of the Code Sl.No. Description Particulars 1. Nam .....

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..... s as stated above are true and correct to the best of my knowledge and belief and no material fact has been concealed. (Signature of the Claimant) Note: If the amount of claim exceeds ₹ 10,000 .....

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