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

……………………………………………………….

Signature of the parties

Witnesses:

(1)

(2)

*Signature of Conciliation Officer

(*In case the settlement arrived at between the employer and his workers otherwise than

in the course of conciliation proceeding the copy of the memorandum shall be marked to

the concerned Deputy Labour Commissioner.)