Dispute Referral Form

WHAT IS THE PURPOSE OF THIS FORM?

This form enables a person or organisation to refer a dispute to the NBCEISA for conciliation only. Should the matter be unresolved the applicant has the right to refer the dispute to the CCMA for arbitration or the Labour Court for adjudication (depending on the nature of the dispute).

WHO FILLS IN THIS FORM?

Employer, employee, trade union or employers’ organisation.

OTHER PARTIES

If there is more than one employee to the dispute and the referring party is not a trade union, then each employee must supply his/her personal details and signature on a separate page, which must be attached to this form.

WHERE DOES THIS FORM GO?

The Regional Office of the NBCEISA in the region where the dispute arose.

OTHER INSTITUTIONS

Please note that if you are covered by a bargaining council, a statutory council or an accredited agency you have to refer the dispute to the relevant council or agency.

If in doubt contact the NBCEISA for assistance.

WHAT WILL HAPPEN WHEN THIS FORM IS SUBMITTED?

When you refer the dispute to the NBCEISA, it will appoint a commissioner who must attempt to resolve the dispute within 30 days.

Step 1 of 5

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1. DETAILS OF PARTY REFERRING DISPUTE

Email Address(Required)

Region of enquiry(Required)

Party Referring Dispute

An employee

An employer

A trade union

An employers’ organisation

Alternative contact details of employee (representative/relative or friend):

Name

Surname

Length of service

ID Number

Salary Gross

Salary Net

Gender (M/F)

Age

Nationality

Postal Address

Postal Code

Tel

Cell

Fax

Alternative contact details of employee (representative/relative or friend):

Name

Surname

Postal Address

Postal Code

Tel

Cell

Fax

(b) Name of the referring party if the referring party is an employer, employer’s organisation or trade union, or if the employer’s organisation or the trade union is assisting a member to the dispute

Name

Surname (if applicable)

Designation

Postal Address

Postal Code

Tel

Cell

Fax

Contact Person

Case No

2. DETAILS OF THE OTHER PARTY (PARTY WITH WHOM YOU ARE IN DISPUTE)

The other party is

An employer

An employee

An employer's organisation

A trade union

FURTHER INSTRUCTIONS
A copy of this form must be served on the other party. Proof that a copy of this form has been served on the other party must be supplied by attaching any of the following:

A copy of a registered slip from the Post Office; or
A copy of a signed receipt if hand delivered; or
A signed statement confirming service by the person delivering the form; or
A copy of a fax confirmation slip; or
A copy of an email confirmation slip; or
Any other satisfactory proof of service.

Name

(If company or close corporation, the name of the company or close corporation)

Surname (if applicable)

Postal Address

Postal Code

Physical Address

Postal Code

Tel

Cell

Fax

Company or close corporation registration number

If a Temporary Employment Service (TES) is involved, the name of the TES

Number of employees employed by the employer

3. NATURE OF THE DISPUTE

What is the dispute about (tick only one box)?

Dismissal (Sec 191)

Mutual Interest (Sec 64)

Severance Pay

S80 BCEA

Freedom of Association

Unfair Labour Practice (Sec 191)

S198 LRA

Refusal to Bargain (Sec 64(2))

S198A LRA (Labour Broker)

S198B (Fixed term contract)

S198C (Part-time Employment)

Interpretation & Application of Chapter 11 (Section 9)

Unilateral Changes to Terms & Conditions of Employment (Sec 64 (4))

UNFAIR DISMISSAL
If the dispute(s) concerns an unfair dismissal the dispute must be referred (i.e. received by the NBCEISA with proof of service) within 30 days of the date of the dismissal or if it is a later date within 30 days of the employer making the final decision to dismiss or uphold the dismissal. If more than 30 days has lapsed you are required to apply for condonation

Other

If it is an unfair dismissal dispute, tick the relevant box

Dismissal (Sec 191)

Mutual Interest (Sec 64)

Severance Pay

S80 BCEA

Freedom of Association

Misconduct

Incapacity

Unknown Reasons

Constructive Dismissal

Poor Work Performance

Dismissal relates to Probation

Operational Requirements (Retrenchments)

where I was the only employee dismissed

where the employer employs less than ten (10) employees

UNFAIR LABOUR PRACTICE
If the dispute(s) concerns an unfair labour practice the dispute must be referred (i.e. received by the NBCEISA with proof of service) within 90 days of the act or omission which gave rise to the unfair labour practice. If more than 90 days has lapsed you are required to apply for condonation.

Other

4. SUMMARISE THE FACTS OF THE DISPUTE

Summarise the facts of the dispute

5. DATE AND WHERE DISPUTE AROSE:

The dispute arose on

The dispute arose where

6. DATE OF DISMISSAL

if applicable

7. FAIRNESS/UNFAIRNESS OF DISMISSAL (if applicable)

(a) Procedural Issues

If yes, why

(b) Substantive Issues

If yes, why

8. RESULT REQUIRED

RESULT REQUIRED

9. SECTOR

Indicate the sector or service in which the dispute arose.

Electrical Contracting

Other

10. INTERPRETER SERVICES

Is an interpreter required?

Language

Afrikaans

IsiNdebele

IsiZulu

IsiXhosa

Sepedi

SeSotho

Setswana

IsiSwati

Xitsonga

Sign Language

Tshivenda

Other

11. CONFIRMATION OF ABOVE DETAILS

Form submitted by

Signature

Position

Date

MM slash DD slash YYYY

Place

I, the undersigned, certify that I have served a copy of the dispute form & or application for condonation as follows:
(a) delivering a true copy to him/her PERSONALLY;
(b) delivering as he/she could not be found, a true copy to (name) a person apparently over the age of 16 years and apparently residing or employed at the Respondent’s place of RESIDENCE/EMPLOYMENT/BUSINESS (delete whichever is not applicable)
by faxing it to fax no and attaching proof of fax report

Name

Fax Number

Address

Time

Day / Month / Year

DD slash MM slash YYYY

Place

Full Name

Company Stamp (if applicable)

Max. file size: 640 MB.

NOTE: IF THE DISPUTE REFERRAL FORM AND OR THE APPLICATION FOR CONDONATION WAS DELIVERED BY HAND & WRITTEN ACKNOWLEDGEMENT OF RECEIPT WAS NOT OBTAINED, THE AFFIDAVIT BELOW MUST BE COMPLETED AND MUST BE DONE IN THE PRESENCE OF A COMMISSIONER OF OATHS (SAPS).

AFFIDAVIT

Name

ID Number

Address

Contact Number

STATE UNDER OATH IN ENGLISH:
Solemnly declare under oath / affirm that I make this statement freely and voluntary without any pressure having been brought to bear on me, or any promises made to me and that I am in sound mind and sober senses. I also declare that the following statement is true to the best of my knowledge or belief, that it may be used in evidence and that I will be liable for prosecution if I wilfully state in it anything that I know to be false:-
That on the (date), I delivered, by hand, a copy of the dispute referral and or the application for condonation (select applicable one) at the following address _______.
The document was given to (Name of recipient) and I was unable to obtain written receipt thereof. (Name of recipient)

I know and understand the contents of this declaration. I have no objection to taking the prescribed oath. I consider the prescribed oath to be binding on my conscience.

Date

MM slash DD slash YYYY

Address

Name of recipient

Deponent

Commissioner of Oath

Consent

I agree to the POPI Act.

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