Form A
(See rule 3)

Form of application for the reference of an Industrial Dispute to a Board of Conciliation
……………………………..
Court of Enquiry
………………………………
Labour Court under section 10(2) of the Industrial Disputes Act, 1947.
……………………………..
Tribunal
……………………………..
National Tribunal
……………………………..

Whereas an industrial dispute ** is apprehended /exists between ……………………………..and ………………………and it is expedient that **the matters specified in the enclosed statement which are connected with for dispute, investigation and settlement relevant to the dispute……………………..should be referred for enquiry by/adjudication
a Board of Conciliation
_________________
a Court of Enquiry
_________________
a Labour Court
_________________ an application is hereby made under sub‑section (2)
a Tribunal
_________________
a National Tribunal

of section 10 of the Industrial Disputes Act, 1947, that the **said matters /said dispute

**a Board of Conciliation.
___________________
a Court of Enquiry.
____________________
should be referred to a Labour Court.
____________________
a Tribunal.
____________________
a National Tribunal.

This application is made by the undersigned who have /has been duly authorised to do has so by virtue of a resolution (copy enclosed) adopted by a majority of the members present at a meeting of the……………..held on the…………….. 20……………..

A statement giving the particulars required under rule 3 of the Industrial Disputes (Central) Rules, 1957, is attached. Dated the ………………..
Signature of employer”……………………..
oragent ………………………………………
or manager…………………………………..
or principal officer of the Corporation ……………
Signature of the
President of the trade union** ……………..
Secretary of the trade union ………………..
Or
Signature of five representatives duly authorised (vide resolution enclosed) ………………………………………..
Or
“Signature of the workman …………………
Or
Signature of the workman in the same establishment duly authorised (vide authorisation enclosed) ……………………….

To
The Secretary to the Government of India,
Ministry of Labour.

Statement required under rule 3 of the Industrial Disputes (Central) Rules, 1957, to accompany the form of application prescribed under sub‑section (2) of section 10 of the Industrial Disputes Act, 1947:

(a) Parties to the dispute including the name and address of the establishment or undertaking involved;
(b) Specific matters in dispute;
(c) Total number of workmen employed in the undertaking affected;
(d) Estimated number of workmen affected or likely to be affected by the dispute;
(e) Efforts made by the parties themselves to adjust the dispute.

Copy to­

(i) The Assistant Labour Commissioner (Central) ……………..here enter office address of the Assistant Labour Commissioner (Central) in the local area concerned;
(ii) The Regional Labour Commissioner (Central);
(iii) The Chief Labour Commissioner (Central), New Delhi.

**Delete whichever is not applicable