FORM A
APPLICATION FOR THE REFERENCE OF AN INDUSTRIAL DISPUTE TO A BOARD OF CONCILIATION / COURT OF INQUIRY / LABOUR COURT / TRIBUNAL / NATIONAL TRIBUNAL
(Rule 3)
[Section 10(2)]

WHEREAS an industrial dispute is apprehended/exists between ____________________ and _________________________ and it is expedient that the dispute/investigation and settle the matters specified in the enclosed statement which are connected with or relevant to the dispute should be referred for enquiry/adjudicating by a Board of Conciliation/Court of Inquiry/Labour Court/Tribunal/National Tribunal, an application is hereby made under sub-section (2) of section 10 of the Industrial Disputes Act, 1947, that the said matters/said dispute should be referred to a Board of Conciliation/Court of Inquiry/Labour Court/Tribunal/National Tribunal.
This application is made by the undersigned who has/have been duly authorised to do so by virtue of a resolution (copy enclosed) adopted by a majority of the members present at a meeting of the _________________ held on the _________________________ 19 ________ .
A statement giving the particulars required under rule 3 of the Industrial Disputes (Central) Rules, 1957 is attached herewith.
Signature
Dated Employer/agent/manager/principal
 officer of the corporation _________________
President of the trade union
Secretary of the trade union ___________
OR
Five authorised representatives_______
OR
Workman ___________________
Workman in the same establishment
Duly authorised____________
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) 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 Asstt. Labour Commissioner (Central) in the local area concerned.
(ii) The Regional Labour Commissioner (Central)]
(iii) The Chief Labour Commissioner (Central).