(See rule 1)


(Under section 1 OA of the Industrial Disputes Act, 1947)

Names of the Parties

Representing employers:
Representing workmen/workman:
It is hereby agreed between the parties to refer the following dispute to the arbitration of……………..[here specify the name(s) and address(es) of the arbitrator(s)]:

(i) Specific matters in dispute;
(ii) Details of the parties to the dispute including the name and address of the establishment or undertaking involved;
(iii) 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;
(iv) Total number of workmen employed in the undertaking affected;
(v) Estimated number of workmen affected or likely to be affected by the dispute.

*We further agree that
the majority decisions of the arbitrator(s) be binding on us.

The 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 arbitration.

Signature of the parties.
Representing employer.
Workman/Representing workman/workmen.



Copy to:

(i) The Assistant Labour Commissioner (Central) ……………….(here enter office address of the Conciliation Officer in local area concerned).
(ii) The Regional Labour Commissioner (Central) ……………………….
(iii) The Chief Labour Commissioner (Central), New Delhi.
(iv) The Secretary to the Government of India, Ministry of Labour, Employment and Rehabilitation (Department of Labour and Employment), New Delhi.

*Where applicable.

**Delete whichever is not applicable.

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