Form I (See Rule 3)

(Memorandum of settlement arrived at during conciliation/or settlement arrived at between

the employer and his workers otherwise than in the course of conciliation proceeding)

Names of Parties:

……………………………….…………….Representing employer(s);

…………………………….……..........…..Representing workers;

Short recital of the case

Terms of settlement: ..........................................................................................

Witnesses: Signature of the parties

(1)

(2)

*Signature of Conciliation Officer

In case the settlement is arrived at between the employer and his workers otherwise than in the course of

conciliation proceedings, the copy of the memorandum shall be marked to the concerned Deputy Labour

Commissioner or Assistant Labour Commissioner and to concerned District Labour Officer.