Form V

(See rule 20)

(AGREEMENT FOR VOLUNTARY ARBITRATION )

Between

………………Name of the parties representing employer (s)

And

…………………. Name of the parties representing worker

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 worker in case he himself is involved in the dispute or the name of the Union, if any, representing

the worker or workers in question.

(iv) Total number of workers employed in the undertaking affected.

(v) Estimated number of workers affected or likely to be affected by the dispute.

*We further agree that the majority decision of the arbitrators shall be binding on us in case the arbitrator(s)

are equally divided in their opinion they shall appoint another person as umpire whose award shall be binding on us.

The arbitrator (s) shall make his (their) award within a period of ........................ (specify the period agreed

upon by the parties) from the date of publication of this agreement in the Official Gazette by the Central Government

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 afore mentioned, the reference to the arbitration shall stand automatically cancelled and shall be free

to negotiate for fresh arbitrator.

Signature of the parties representing employer/ any officer of the Trade Union / Representing worker / workers.

Witnesses:

1. ..................................

2. ..................................

Copy to: (i) The conciliation officer [Enter office address of the conciliation officer for the area concerned].

(ii) The Secretary to the Government of India, Ministry of Labour and Employment.