for agreement between the Employer and Employees for Reference of Disputes to
of the Parties;
It is hereby agreed between the
parties to refer the following dispute to the arbitration of
.............................. [here specify the name(s) and addressees)
of the arbitrator(s)]:
i. Specific matters
Details of the parties to the dispute including the name and address of the establishment or
Name of the workman in case he himself is involved in the dispute or the name of the Union,
if any, representing the workmen or workman in question;
Total number of workmen employed in the undertaking affected;
Estimated number of workmen affected or likely to be affected by the dispute.
further agree that the majority decisions of the arbitrator(s) be binding on
us. In case the arbitrators are equally divided in their opinion, that they
shall appoint another person as umpire whose award shall be binding on us.
arbitrator(s) shall make his (their) award within a period
of............................ (here specify the period
agreed upon by the parties) or within such further time as is extended by
mutual agreement between us in writing. In case the award is not made within
the period aforementioned, the reference to arbitration shall stand
automatically cancelled and we shall be free to negotiate for fresh
Signature of the parties.
WORKMAN / WORKMEN WITNESSES;
The Assistant Labour Commissioner (Central), .................. (here enter office address of
the Conciliation Officer in local area concerned).
The Regional Labour Commissioner (Central)...........................
The Chief Labour Commissioner (Central), New Delhi.
The Secretary to the Government of India, Ministry of Labour, Employment and Rehabilitation
(Department of Labour and Employment), New Delhi.