REFERRAL OF A DISPUTE FOR CONCILIATION & CON-ARB
Sections 9, 64, 133, 134, 135, 191, 198 &198A-C Labour Relations Act, 1995 Tokiso LRA Rule 10
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1. PARTY REFERRING THE DISPUTE
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Step
1
of 9
Party Referring the Dispute
Name
*
First
Last
Length of service
Salary gross
Salary net
Gender
Male
Female
Other
Age
Telephone number
*
Cell phone
*
Email
*
Nationality
South African
Other
Physical Address
Code
Type of employment :
Full time
Fixed term contract
Part-time employee
Non-Standard employee
Labour
Other
Please provide alternate contact details for the employee (representative, relative or friend):
Name
Relationship
Cell phone
Email
Complete this section if you are a union or employer organisation (whether referring in this capacity or assisting a member)
Name
Surname
Organisation
Designation
Telephone
Cell phone
Physical address
Code
Next
Name of employer
*
Company registration number
Company VAT number
Number of employees employed by the employer
Physical address
*
Code
Full name and surname of company contact
*
Telephone
*
Cellphone
*
Email
*
Position
*
If a Temporary Employment Service (TES) is involved, the name of the TES:
Name of TES
Contact
Email
Telephone
Cellphone
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Please indicate what the dispute is about
*
Unfair dismissal
Interpretation/application of a collective agreement
Unfair labour practice
Unilateral changes to terms & conditions of employment
Severance pay
198, 198A, 198B, 198C or 198D atypical employment
Mutual interest
Other
If Other please specify
If the nature of the dispute is an alleged unfair dismissal, please complete the following:
What was the reason for the dismissal
Misconduct
Constructive dismissal
Incapacity: ill health
Incapacity: poor work performance
Incapacity: Incompatibility
198, 198A, 198B, 198C or 198D atypical employment
Retrenchment – 1 employee (Operational Requirements)
Retrenchment – employer has less than 10 employees (Operational Requirements)
Unknown
Probation dismissal
Other
If Other please specify
What was the date of dismissal?
Where did the dismissal take place (town/city)?
Was the dismissal procedurally unfair, i.e. the correct procedure was not followed?
No
Yes
If yes, please state why
Was the dismissal substantively unfair, i.e. was the reason for dismissal unfair
No
Yes
If yes, please state why
If it is an unfair labour practice dispute, please complete the following:
Promotion
Provision of benefits
Demotion
Probation
Training
Unfair suspension
Failure/refusal to reinstate/reemploy a former employee in terms of any agreement
What was the date of the unfair labour practice?
Where did the unfair labour practice take place (town/city)?
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Please summarise the facts of the dispute:
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What outcome do you want from this dispute?
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Please select where you would prefer the conciliation / con-arb to take place
Online
Tokiso to arrange a venue
Employer Premises
Other
Address / Location
This case is estimated to take (day/s)
Please indicate agreed date/s for hearing:
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Have the parties agreed to a commissioner from Tokiso’s panel?
No
Yes
(If Yes) Name of commissioner
Do you require an interpreter for the conciliation / con-arb?
No
Yes
(If Yes) Which language/s
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You have a right in terms of section 191(5A)(c) of the LRA to object to the arbitration commencing immediately after the conciliation. Please indicate if you object to this
No, I don’t object to the con-arb process
Yes, I object to the con-arb process
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I attach
Confirmation that the parties have agreed to have this case referred to Tokiso.
Confirmation that the parties have agreed to the commisisioner (if applicable).
Proof of service of this form on the employer.
(Max file size 5Mb)
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I confirm that I am authorised to sign this form.
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