Form XI

(Agreement for voluntary arbitration) [See rule 35 (1)]

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 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 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 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 Labour Commissioner, LESDE Department.