Names of Parties
Representing employer(s):
Representing workmen:
Short Recital of the Case
Terms of settlement
Signature of the parties
………………………….
…………………………
Witness:
(1)
(2)
Conciliation Officer
Signature of ……………….
Board of Conciliation
Copy to:
- Assistant Labour Commissioner (Central) ……………………………. [Here enter the office address of the Assistant Labour Commissioner (Central) in the local area concerned].
- Regional Labour Commissioner (Central) ……………………………..
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