Form V

Made under The Industrial Relations Code, 2020G.O.Rt. No. 111, 12 Jun 2026

Official text

Open in the official PDF (pp. 43–44)

Tables and forms lose their layout when extracted; the PDF is the authoritative version.

(See rule 22)

(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 under taking 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 ........................

(here specify the period agreed upon by the parties) from the date of publication of this

agreement in the Official Gazette by the State 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 we 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 [here enter office address of the Conciliation Officer for

the area concerned].

(ii) The Principal Secretary, Labour, Factories, Boilers and Insurance Medical Services

Department , Government of Andhra Pradesh, AP Secretariat, Velagapudi, Guntur

District.

Source: The Industrial Relations (Andhra Pradesh) Rules, 2026, G.O.Rt. No. 111 — Andhra Pradesh Gazette Extraordinary (as ordered by G.O.Rt. No. 111), pp. 43–44 of the PDF. Open our copy at p. 43 · official download · all sources

Text from the Government Order that orders the notification's publication in the Andhra Pradesh Gazette; the Gazette issue itself was not found on the AP e-Gazette.