Form XII

[See Rule 34 (1)]

Agreement for voluntary arbitration

BETWEEN

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

And

………………….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 arbitrator(s) 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] 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 Additional chief Secretary/Principal Secretary/Secretary, Labour Resources

and Migrant Workers Welfare Department.