SOUTH AFRICAN LOCAL GOVERNMENT BARGAINING COUNCIL HEAD OFFICE 461 King Dinuzulu Road Private Bag X16 BEREA MUSGRAVE 4062 4082. E-mail: info@salgbe.org.za Tet: (031) 201-8210/6219/6255 Web-site: www. salgbc.org.za Fax: (031) 201-9768 28 June 2024 TO: ALLMUNICIPALMANAGERS ALL HUMAN RESOURCES DIRECTORS THE PARTIES SALGA Mr. § Mbanga smbangatsalenore a SAMWU Mr. D Magagula unissoLmsgeauat@sammucreza IMATU Mr. J Koen inhanimatu.co.20 REGIONAL SECRETARIES: Gauteng/Johannesburg/Tshwane Division Ms. E. Sekgweleo ssmealds@saleteoreza Eastern Cape Division Mr. C. Gqeke Chumanissaite 19.28 Western Cape/Cape Metro Division Ms. W Brink vwimadaalbe oa Northern Cape/Free State Division Mr. TMgobongo Thabiso@salgbe.o1¢.20. Northwest/Mpumalanga/Limpopo Division Ms. D Monyemangene Diksledisagneorg.za KwaZulu-Natal/eThekwini Division Mr. VNzuza uisi@salgbe.orgza CIRCULAR NO: 3/2024 SALGBC DISPUTE RESOLUTION FORMS - 1 JULY 2024 ‘The Executive Committee has revised the SALGBC’s dispute resolution forms and has approved a total of twelve (12) new dispute and/or related forms, as attached hereto. ‘These revised dispute resolution forms shall come into effect on 1 July 2024. The forms have been adapted and aligned with the SALGBC’s revised Rules for the Conduct of Proceedings, which came into effect on 1 January 2024 (Circular 12/2023) Kindly note that in terms of the transitional provisions, all old forms received by the Council before 30 June 2024 shall be processed accordingly. The new forms shall apply as from 1 July 2024. ‘These forms must be used / read in conjunction with the Rules for the Conduct of Proceedings before the SALGBC. The forms are available on the SALGBC's website: www.salgbo.org.za Yours faithfully “Address correspondence to the General SecretaryLRA UA 5135, 191(2),198en¢ | REFERRING A DISPUTE TO THE COUNCIL 198A-C ule 10of saucecrules | FOR CONCILIATION (INCLUDING CON-ARB; Form 7.12 SALGBG 1995 NATIONAL/DIVISION: WHAT IS THE PURPOSE OF THIS FORM? This form enables a person or organisation to refer a dispute to the South African Local Government Bargaining Councit (“Councit’)for conciliation and con-arb. WHO FILLS IN THIS FORM? ‘Any party to the dispute, such as an employer, employee, Trade Union or employer's organisation. WHERE DOES THIS FORM GO? “To the Regional Secretary of the Council in the Division where the dispute arose or ifthe dispute is @ national dispute to the General Secretary of the Council (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. WHAT WILL HAPPEN WHEN THIS FORM IS SUBMITTED? When you refer the dispute to the Council, the Council will attempt to resolve the dispute, through conciliation, within 30 days of the date of referral. 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 one of the following: A copy of a registered slip from the Post Office; or * Acopy ofa signed receipt if hand delivered; or Assigned statement confirming service by the person delivering the form; or = A copy ofa fax or email confirmation slip or sent email; or = Any other satisfactory proof of service; and supporting documents. PLEASE NOTE The following disputes must be forwarded directly to the CCMA and cannot be dealt with by a Bargaining Council in terms of the Labour Relations Act, No 66 of 1995 (of the Act). = Disclosure of information disputes ( 16 and 189 of the Act); = Organisational rights disputes (Chapter 3 part A of the Act); = Agency shop disputes (25 of the Act}; Closed shop disputes ( 26 of the Act); Interpretation or application of collective bargaining provisions ( 63(1) of the Act) = Picketing disputes relating to breach of collective agreement; picketing agreement or picketing rules - $69(8); = Workplace forum disputes ( 86 and 94 of the Act). Unfair Labour Practice If the dispute(s) concerns an unfair labour practice, the dispute must be referred within 90 days of the actor omission which gave rise ‘to the unfair labour practice. If more than 80 days has lapsed, you ae required to apply for condonation. If it isan unfalr labour practice, state whether it relates to probation. Please turn over .. APPROVED BY THE EXECUTIVE COMMATTEE ON 20,UNE UzREAD THIS FIRST PARTA REFERRING A DISPUTE TO THE SOUTH AFRICAN LOCAL | GOVERNMENT BARGAINING COUNCIL Tick the correct box EI IMPORTANT The employee/referring party complete ll the details in 1) must ‘The name of the employee or an employer that is referring the dispute must be filed in | @, If there is more than one employee to the dispute and the referring partyisnotatrade union, then each employee must supply ‘thelr personal details and signature on a separate page, which must be attached to this form. ‘The name of the trade union or employer's organisation that is referring the dispute or assisting @ member to refer a dispute must be filled in (b). if there Is more than one party, please provide all the details of each party on separate page which must be attached to ths form. Tick the correct box BAT 41, DETAILS OF PARTY REFERRING DISPUTE Ditrace union D1 an employers’ organisation Danempioyee D1 Anemployer (a) Name of the Party ifthe referring party is an employee or employer Surname: ID Number: Department: Salary Net: Nationality Salary Gross: Gender (M/F): Postal Address: Age: « Code: Tel:. Cel Email. Fax: {b) Name of the referring party who will represent the applicant (name of official if the referring party is an employer's organisation or trade union, or if the employer's organisation is assisting a member to the dispute Name of Party or Organisation: Name: Surname: Postal Address: Physical Address: Tel: Fax: 2. DETAILS OF THE OTHER PARTY (PARTY WITH WHOM YOU ARE IN DISPUTE) 1 nemployers’ organisation DD atrade union D anemptoyer D1 anemployee | SALGBC CASE NUMBER. ‘APPROVED BY THE EXECUTIVE COMMITTEE ONZE NE 224[MUTUAL INTEREST DISPUTES Attach the collective agreement on picketing; oF + If no collective agreement on picketing complete Annexure Ato this form. «If referring 3 request for establishment of picketing rules, complete Annexure A to this form. UNFAIR DISMISSAL DISPUTES Hf the dispute concerns an alleged unfair dismissal, the dispute must be referred (ie. received by the SALGBC) within30 days of the date of dlemissal. If more than 30 days has lapsed, you are required to apply for condonation, The referral, together with the application for condonation must be sent to the Counell, together with proof of service to the municipality UNFAIR LABOUR PRACTICE Hf the dispute concems an_unfair labour practice, the dispute must be referred (ie. received by the SALG8C) 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. The referral, together with ‘the application for condonation must be sent to the Council, together with proof of service to the municipality 1. NAME OF MUNICIPALITY (ifmuniipal owned en, the company or close corporation, the name ofthe MOE, company oF lose corporation: Contact person: Postal Address: Code: Physical Address: Code: cel Email: Tel: FAKE ocean Number of employees employed by employer: 2. SECOND RESPONDENT Name(s): Contact person: Postal Address. Code: Physical Address: cel Email Tel Fax 3. NATURE OF THE DISPUTE ‘What is the dispute about (tik only one box)? D vismissai DD mutuatinterest D1 unitateral change to terms & conditions of employment 1 pisputes by essential Services employees 1 interpretation or application of collective agreement concluded at: D1 central council evel D1 oivisiona tevel D1 ur or Municipat level D1 refusal to Bargain DD disputes about Freedom of Association D untairiabour practice (probation) 1 untairiabour practice (other) - please give detois interpretation and application of sections 198A-C ofthe LRA referred in terms of $1980 DD siss uaa CD sizga (Temporary Employment Services) Di sizes (Fixed Term Contract) D sissc (part-time Employment) ‘APPROVED BY THE EXECU ‘COMMITTEE 020. 2026,JT sis8aca) una (Dismissal) Application for determination of Picketing Rules ~ S69(68) Other - please give details Ifyou have submitted another dispute which Is similar or related to this dispute, please specify the SALGBC case number? Ifit is unfair dismissal dispute, tick the relevant box. OD misconduct D incapacity 1 Unknown Reasons D1 constructive dismissal D1 Poor work performance D1 dismissal relates to probation 1 operational Requirements (Retrenchments) 1 where | was the only employee dismissed D1 where the employer employees less than 10 employees D1 other (specity.. | 4, SUMMARIZE THE FACTS OF THE DISPUTE (Use additional paper if necessary): S5.DATE AND WHERE DISPUTE AROSE: The dispute arose on: 7 (sive the date, day, month and year) The dispute arose where: (give the CityTown in whieh te dispute arose) 6.DATE OF DISMISSAL (if applicable}: .. 7.FAIRNESS/UNFAIRNESS OF DISMISSAL (if applicable) (2) Procedural issues Was the dismissal procedurally unfair? LI ves C1 no If yes, why? (©) Substantive Issues Was the reason for the dismissal unfair? LI ves EI no IF yes, Why? sa ‘PPROVED UY THE EXECUTIVE COMATTEE OW INE 2.‘S.RESULT REQUIRED | ‘9.INTERPRETER SERVICES Parties may, at thelr own cost, bring interpreters for languages other than the official South African languages. Please indicate this under “other. Daasicans Disindevele = Disizutu Disixhosa Dsepesi Disesotno Disetswana Disiswati Dxitsonga Is an interpreter required? Yes/No | (Disign tanguage DA tshivenda Dlother (specify) Please see note 10.SPECIAL FEATURES / ADDITIONAL INFORMATION, special features might be a reason for the | Briefly outline any special features / additional information SALGBC needs lrgency of the matter, the large number of | to note: people involved, important legal or labour | ispute about unilateral change to terms and conditions of employment s64(4) \/we require that the employer party not implement unilaterally the proposed changes that led to this dispute for 30 days, or that it restore the terms and conditions of the ‘employment that applied before the change. po Signed: {employee party referring the dispute) 111. PLEASE INDICATE HOW MANY WITNESSES WILL BE CALLED: Applicant Dito2 Datos Datos Dc ormore Respondent Ditoz Datos Dhatoe = Ds or more APPROVED BY THE EXECUTIVE COMMITEE ON20 UNE 2026,12, POPIA CONFIRMATION By signing this document, I/we hereby grant my voluntary consent that my/our personal information may be processed, collected, used and disclosed in compliance with the Protection of Personal Information Act, 4 of 2013. I/we furthermore agree that my/our personal information may be used for the lawful and reasonable purposes in as far as the SALGBC (responsible party) must use my/our information in the performance of its public legal duty. I/we understand ‘that my/our personal information may be disclosed to a third party in as far as the SALGBC must fulfil its public legal duty. I/we furthermore understand that there are instances in terms of the abovementioned Act where my express consent is not necessary to permit the processing of personal information, which may be related to litigation or when the information is publicly available. 13,CONFIRMATION OF ABOVE DETAILS Form submitted by: {Please print name) Signature: . | Position: | | APPROVED BY THE EXECUTIVE COMMITTEE ON 20 JE 202| reantasensr PART B TO BE COMPLETED FOR DISMISSAL DISPUTES ONLY | SOUTH AFRICAN LOCAL GOVERNMENT BARGAINING COUNCIL 1. COMMENCEMENT OF EMPLOYMENT ‘When did you start working at the employer (or municipality) Dismissal oisputes must be referred within 30 | 2, NOTICE OF DISMISSAL | days of dsmisal. tf the | | dismissal was more than | | 30 days ago, you are | | teaured 0 9P017 fF | How were you informed of your dismissal? condonation | completing Partcotthis | C1 gy tetter D vervatty form | DD pvattera ciscipinary hearing C1 constructive (resigned) | | | when were you dismissed? D1 avattera aiscipinary appeat hearing D other (please describe) 3. REASON FOR DISMISSAL | why were you dismissed? Tick the correct box DO misconduct D incapacity Doperational Requirements Doknown {(Retrenchment) Dror work Performance Dconstructive dismissal D1 other (please describe) 4, FAIRNESS/UNFAIRNESS OF DISMISSAL Tick the correct box |) Procedural tssues a ‘Was the dismissal procedurally unfair? Dives Ono It yes, why? (b) Substantive Issues \was the dismissal substantively unfair? D ves D1 no if yes, why? APPROVED BY THE EXECUTE COMMATTEE ON 20 JUNE 2128PART C CONDONATION APPLICATION — ‘THE APPLICATION MUST BE SUPPORTED BY A WRITTEN STATEMENT OR AFFIDAVIT TO BE COMPLETED IF YOUR REFERRAL IS OUT OF TIME SOUTH AFRICAN LOCAL GOVERNMENT BARGAINING COUNCIL _ ONLY FILL THIS OUT IF THE CASE HAS BEEN REFERRED LATE ase number (if already given): Applicant Name: Occupation: Respondent Name: Position. _ 7 AFFIDAVIT — - 1 the undersigned. .c-snussn-nnne fullname of applicant] do hereby make an oath and say 1. BACKGROUND 1. Iwas dismissed Of sss ss (aive dete) 1.2. The employer refused to reinstate Me OM wn so flve dote) 1.3, The dispute 21080 ON enn ns (give date afte all attempts to negotiate or follow other internal procedure filed. 2. THE DEGREE OF LATENESS 2a The referral isn nays ate 2.2. | did the following to pursue my rights after my dismissal | {1 went to my union/the department of Labour / Community advice centre / Legal advice centre (dete Uehich sno opicoble) ON “ (ove dote) (ii) I telephoned sv (give name) 07 srssnsrnnon (give date) (ii) signed the referral form (give date) 3. REASONS FOR LATENESS ‘The reason that | referred the matter late is 4, PROSPECTS OF SUCCESS | eteve that hove a good case because (ou mus expan with good eesons why you wll wn yourcose) L _ a = APPROVED BY THE EXECUTIVE COMMITTEE ON 20 JUNE 202,5. PREJUDICE 5.1. As the employee party, if condonation is not granted, | will be prejudiced because- 5.2. As the employer party, if condonation is granted, | wll be prejudiced because ~ 6. GENERAL Please give any other information that will support your application. Signature of applicant: Name of applicant: Occupation of applicant: Commissioner of oaths Signed before me on . at a bby the deponent who acknowledges that he / she knows and understands the contents of the affidavit, has no objection to taking the cath / affirmation and considers it binding on his / her conscience. Name: Address: Capacity: NOTE: Please attach any documentary proof that supports your application. If there is insufficient space under any of the above questions, please attach additional pages of information. APPROVED Y THE EXECUTE COMMITTEE ON 2 JUNE 2004| ONLY FILL THIS OUT IF THE CASE HAS BEEN REFERRED LATE ‘Case number (if already given): Occupation: | Appticant Name: Position... Respondent Name: WRITTEN STATEMENT |, the undersigned, “Gul name and the capocty of perc making the written statement ~e¢. Bonga Xing, employee) do hereby declare that the following information is accurate and that | understand that | may be required to confirm the content of this written statement under oath or affirmation before a commissioner of the SALGBC. GROUNDS FOR CONDONATION (This section must be completed) 4, Degree of Lateness (lease use Information Table One to determine the degree of lateness fora referral document and Information Table Two to determine the degree of lateness for an application document) days 1.1 The referral or the delivery of the application documentation is late, 2. Please set out the reasons for the late delivery of the referral or application document(s) 3. The referring party's prospects of succeeding with the referral or application and obtaining the relief sought | against the other party (Please set out why you believe you are likely to succeed with your dispute referral or the | application ~ including notice of opposition to the application.) 4, Any prejudice to the other party (What prejudice [aisadvantage, if any, do you think your late referal or submission of application documentation may have forthe other party.) 5. Any other relevant factors? {include any other information that you believe will assist the commissioner to determine your application for condonation.) Signature of Applicant or duly authorised representativeu Information Table One: Time period for the referral of a dispute to the SALGBC [NATURE OF DISPUTE NUMBER OF DAYS TO REFER alleged unfair dismissal | (Conciliation or con-ar’ application) uphold the dismissal. ‘CONCILIATION OR CON-ARB: Refer within 30 days of the date of dismissal or ifitis @ later date, within 30 days of the employer making a final decision to dismiss or to ‘ARBITRATION: Refer within 90 days of the earlier of the expiry of the 30-day conciliation period or the date of receipt of the certificate of outcome. ‘illeged unfair labour practice Information Table Two: Compliance with time periods set ou When calculating days, please exclude the first day and include the last day in your calculation. "ARBITRATION: Refer within 90 days of the earlier of the expiry of the 30-day conciliation period or the date of receipt of the certificate of outcome. T CONCILIATION OR CON-ARB: Refer within 90 days of the act or omission which | allegedly constitutes the unfair labour practice or, if it isa later date, within 90 days | ofthe date on which the employee became aware of the at or occurrence the SALGBC Rules. SAUGBC RULE ‘APPLICATION [NUMBER OF DAYS TO SUBMIT [Rule 9 Application for Condonation for 2 dispute referred in terms ofthe LRA, BCEA cor EEA ‘Opposing an application (Rule 31(5)) Within 5 days after receiving the application. Replying to an application to oppose the application (Rule 31(6)) Within 3 days after receiving the application | to oppose and opposing statement, Rule 17 Conduct of a con-ar ‘Notice of objection to a con-arb hearing. Notice to be served at least 7 days prior to | the date of the hearing, Rule 20 When the parties must hold a pre-arbitration conference Convening a pre-arbitration conference (Rule 20(2), | Pre-arbitration conference must be convened at least 14 days prior to the date of the | arbitration or as directed in terms of Rule 20(1){c). Delivering a copy of the pre-arbitration minute, Pre-arbitration minute to be delivered to the commissioner at least 7 days prior to arbitration or as directed in terms of Rule 20(4)(c) Rule 23 How to postpone an arbitration Delivering written confirmation by both parties to agree to postpone (Rule 23(2}(b)) Application to postpone an arbitration hearing ~ used in the absence of agreement ‘of both parties to postpone. (Rule 23(3) read with Rule 31(2)) Opposing an application (Rule 31(5)) Written confirmation of agreement to postpone delivered to the Council at least 7 days prior to arbitration. Within 14 days of the date of the hearing. Within 5 days after receiving the application. Replying to an application to oppose the application (Rule 31(6)) Within 3 days after receiving the application to oppose and opposing statement. Rule 25 Representation before the Council ‘Application for representation. Rule 32(2)) ‘Within 14 days of the date of the hearing. | ‘Opposing an application (Rule 31(5)) Replying to an application to oppose the application (Rule 31(6)) ‘Within 5 days after receiving the application. | Within 3 days after receiving the application to oppose and opposing statement, APPROVED BY THE EXECUTIVE COMMITTEE O40 JUNE 2242 ‘SALGBC RULE ‘APPLICATION NUMBER OF DAYS TO SUBMIT Rule 26 How to join or substitute parties to proceedings - OR Rule 27 How to correct the citation of a party. ‘Application for substitution or joinder or to ‘correct the citation. Rule 31(2)) Within 14 days of the date of the hearing. ‘Opposing an application (Rate 31(5)) Within 5 days after receiving the application. Replying to an application to oppose the application (Rule 31(6)) Within 3 days after receiving the application to oppose and opposing statement. Rule 29 Disclosure of documents or material relevant to the dispute. ‘Application for disclosure (Rule 29(1)). | Responding to the application. ‘Application to be made not less than 14 days of the arbitration hearing date. Within 5 days from the date of receipt of the application. | Repvng othe response received tothe application Within 3 days from the date on which the responding or answering statement was, received. Rule 32 How to apply to vary or rescind awards or rulings. ‘Application (Rule 31(2)) ‘Opposing an application (Rule 31(5) Replying to an application to oppose the application (Rule 31(6)) Within 14 days of the party becoming aware of the arbitration award or ruling. Within 5 days after receiving the application. Within 3 days after receiving the application | [Rule 33 How to apply to refer a dismissal dispute to the Labour Court (s191(6) of the LRA). ‘Application to refer a dismissal dispute that falls within the jurisdiction of the CCMA to the Labour Court (Rule 33) | to oppose and opposing statement. For the employee: Within 90 days of the expiry of the 30-day conciliation period, or if earlier, within 90 days of the issuing of the certificate of outcome. For the employer: within 14 days of the request for arbitration being filed. (Objection to the s191(6) application. Within 7 days of receipt of the application. Replying to an application NA Rule 37 How to have a subpoena issued and served. Rule 378 Expert witnesses. Request for a subpoena (Rule 37(3)) Provision of additional information by the applicant’ upon request from the commissioner. [Provision of @ written response by the ‘opposing party (only if requested by the commissioner) Provision of notice to call an expert witness to the Council and the other party to the dispute. ‘At least 14 days prior to the arbitration hearing, or as directed by the commissioner | hearing the arbitration Within 3 days of receipt of the request or as directed by the commissioner hearing the arbitration. Within 5 days of receipt of request from the commissioner, or as provided in the written request. Notice, together with a summary of the proposed evidence of such witness must be given 7 days prior to the hearing. APPROVEDBY THE EXECUTIVE COMMITTEE ON 20 JUNE 224,2 GUIDELINES TO COMPLETING AND RESPONDING TO CONDONATION APPLICATIONS ‘The Labour Relations Act gives timeframes for the submission of referrals, applications and other documents. ‘A.condonation application needs to be completed where the timeframes for submissions are not met. The mest common type of condonation application is for the late submission of the referral form (i.e. the referral is served more than 30 days after the date of dismissal or after 90 days after the alleged unfair labour practice). If you refer your case outside of the timeframes which are indicated, you will need to complete C of this referral form and send it together with your referral form. These guidelines should assist you, ‘THE APPLICANT (REFERRING PARTY) The application must be in the form of a sworn affidavit or written statement, and the application form isin this format to assist you. The following issues must be dealt with in your application: 1 The degree of lateness and the reason(s) for the delay. You must give reasons for the lateness that account for the full period that the referral was late, Its. for example, not sufficient to say you were in hospital for a week ifthe referral is 6 weeks late. This ‘would explain only the one weeks’ lateness and not the other 5 weeks. Proofis also required. For example, just stating you were in hospital without proof does not carry much ‘weight. If proof cannot be supplied, give reason why not. If the referral has been incorrectly made to the CCMA or another bargaining council, the reason for the mistake must be given. 2 Prospects of success You must state why there is a good chance of your case being successful should it eventually go for arbitration or to the Labour Court. Enough detail must be given to allow the employer to respond. For ‘example, just stating that the chair of the disciplinary hearing was biased is not enough. Reason for and, if available, proof of the allegation must be given. 3 Prejudice Personal circumstances and whether you have obtained other employment are important. Any other circumstances must also be mentioned. 4 Theimportance of the matter Ifthe matter is important from a general policy viewpoint, such as potential unrest, it must be stated. 5 Anyother information that is important You can give any other information that you think supports your application. Please attach any document that supports your application. ‘THE RESPONDENT Should you wish to respond to the applicant's affidavit or written statement, it must reach the offices of SALGBC within 5 days of receiving the application. It should deal with the issues raised in the application and must also be in the form of an affidavit or written statement. Proof of service must be attached. ‘The applicant then has 3 days to respond to the respondent's affidavit or written statement. NOTE: Any party experiencing difficulty with the process must obtain assistance from a knowledgeable person (organisation. The council is not legally permitted to assist with the substance of your application. Ifyou have any queries on the process, you may contact SALGEC, APPROVED BY THE EXECUTIVE CONMATEE 08 20.U 924,14 CONTACT DETAILS OF OFFICES OR DIVISIONS OF THE COUNCIL Hood office (Contra Counc) Tek (031) 201-8210 E-mail: info@salgbe.or2a Physical Address 463 King Dinuzul Read (South), Ourban, 4082 Gauteng Regional office {Gauteng Division Johannesburg Metropolitan Dision Tel (012) 665-0248 Tek: (012) 665-0249 mal: info.g@salgbe orga E-malinfo g@salgbe og 23 Physical Address 3 Einstein Steet, Highveld Physleal Address: 3 Einstein Street, Techno Park, Centurion, Gauteng, 0157 Highveld Techno Park Centurion, Gauteng. 0157 Eastern Cape Regional Office Easter Cape Divison Tek (081) 581-3222 041) 3813672 E-mat infoece@salge.org20 hyslel Address: 33 Haugh Road, Walmer, Port Elzabeth, 6070, wazulutatal Reglonal Office ‘Tehwane Meteopottan Oivision Tet: (032) 655.0289 E-mail infog@salgbcorgze Physical Address: 3. Einstein. Steet, Highveld Techno Park, Centurion, Gauteng, 0157 c|hekwni Metropolitan Duision KwaZulu-Natal Dison Tet (031) 201-8210 Tel: (032) 201.8210 E-mail: infoken@salgbe. orga Email infoken@salgbc orga Physical Adaress 461 ing Diuzulu Road yslal Address 461 King Dnuzuly Road (South), Durban 4062 (South), Durban, 4062 Westara Cape Regional Office Western Cape Division Cape Town Metropolitan sion Tek (021) 917-1141/2/3 Tek (023) 927-1203 /2/3 E-mail: info me@salebe.org22 mall: info.e@salebe og. Physical Address: 7 Oe Villers Sree, Belvile, Physical Address: 7 De Villers Street, Belle, Cape Town, 7522 Cape Town, 7532 North West/Mpumatanga/Limpope Regional Office Mpumalanga Diision North-West Divison “el 012) 342-3428 (012)382-8792 Tel: (012) 242-3428 / (012) 342-8792 -ma:info.nw@sslgbe 076.29 mall: info.nw@salgbe 07824 Physical Address: 3 Einstein Steet, Migweld Physical Address: 3 Ensen Street, “ehno Park Centurion, Gauteng, 0157 Highveld Techno Park, Centurion, Gauteng, 0157 Northern Cape/Free State Reglonal Office Limpope Division “els (012) 342-3428 / (012) 362-8792 small: info nw@salghe.orgca Physical Address: 3. Einstein Steet, Hghveld Techno Patk, Centurion, Gauteng 0157 Northern Cape Ovsion Free State Dvson Tel: (053) 82-125/6 “eb (053) 692-1215/6 smal: info s@saebe.org2 small: info ss@salgoc.og.28 Physical Address: 10 Holand Road, New Park, Physical Address: 10 Holland Road, New Park, Kimberley, 8300, Kimberley, 8300 APPROVED BY THE EXECUTIVE OOMMATEE ON 20 JUNE15 ASNEIURETATOUAFROM |” |NFORMATION RELEVANT FOR THE DETERMINATION OF : PICKETING RULES NB! This annexure fs important {o complete wihen referring 8 |, DETAILS RELATING TO THE POSSIBLE PICKET AT THE MUNICIPALITY matter of Mutual intrest WHAT IS THE PURPOSE OF (a) Nature of the workplace “Tils ANNEXURE? ‘This annexure will place the Commissioner in possession of relevant information to enable himjher to meaningfully assist the parties inthe establishment of picketing rules in fine with {a aiance om lace to which publ ha acces, ving acormodaionsuated on see employer premises ete) (b) Describe the particular situation of the workplace (c)_ The number of employees taking part in the picket inside the premises ‘WHEN MUSTTHIS ANNEXURE | (4) Is there potential for violence and other unlawful acts: Yes|_] No} | ‘BE COMPLETED? (yesh) When referring 2 matter of | Mutual Interest, which might si Bive rise to a protected strike _ | ‘and there is no collective ‘agreement regulating picketing. | _(e) Physical address ofthe premises where the picket is conducted | | necessary, write the detals or ‘any additional information on a separate page and attach it to (f)_ Areas identified for the picket this form. (@) Time when the picket will start (h) Duration of the picket i) The proposed movement of persons participating inthe picket IMPORTANT!!! ® prop p m ating , 1. There will be no protected picket without picketing rules () Measures proposed by the trade union to exercise control over the picket 2. Attach the MSA or MSD, if applicable. SIGNATURE: DATE: (k)_ Any other relevant information PROVED BY THE EXECUTIVE COMMITEE ON 20 UNE 2(RAFomm7a2 una 98 SALGBC Sener, sie CERTIFICATE OF OUTCOME OF DISPUTE 136(2)(a) REFERRED TO CONCILIATION CASE NUMBER... 1We certify that the dispute between: ° (etering pay) Concerning and Referred to conciliation on: Remains unresolved ‘fcther patyfartes) Was resolved on the .sniesessee or asal essa (give date) (give date) Both patties in attendance Yes No Condonation: Granted —_| Not applicable lr this dispute remains Referto | Referto Interest/ Strike! | Refer to Labour unresolved, Arbitration ‘Advisory Lockout | Court the following steps may be Arbitration | taken: tL Name of the Commissioner Signature of the 5] Prov oe ane Place / Province Date Ofcil stamp of th South ican Local Government Bargaining Council [APPROVED BY THE EXECUTIVE COMMITTEE ON 20,UNE2024LRA Form 7.124 SALGBC La 2995, 565 216, CERTIFICATE OF OUTCOME OF ESSENTIAL ere SERVICES DISPUTE REFERRED TO CONCILIATION CASE NUMBER: We certify that the dispute between: and “etering pany) “eter pary/partes) Referred to conciliation on: Give date) Concerning Matters of Mutual Interest . ~] Remain unresolved a8 at......:eeese (give date) (sive date) Was resolved on the |ifthis dispute remains unresolved, | Minimum Service | Minimum Services | NO MSA/MSD the Commissioner must tick the | Agreement (MSA) | Determination (MSD) applicable box. Parties have: L sere If parties have an MSA or MSD [Only the parties in the Interest Arbitration (ir majority —] (Pa Figo may strike | ballots in favour my | if parties have no MSA or MSD Interest Arbitration Name ofthe Commissioner | Stature ofthe Commissioner | piace) Province Date Official stamp ofthe Sout ican Local Goverment Barasining Council [APPROVED BV THE EXECUTIVE COMMITTEE ON 20 UNE2024Tino Ts tha 95 545 61,74, 136 101 186860. REQUEST FOR ARBITRATION ule 1 of SABC Rules ad This Fist Name Postal Ades: WHAT IS THE PURPOSE OF Occupation: (i ems THIS FORM? pa move Tel: condition fais, apary may | Gg request that the Council to resolve the dispute by Contact Person. ativan, he depute sritable. 2, DISPUTE DETAILS WHO FILLS IN THIS FORM? The case between The party requesting the atbiraton, and WHERE DOES THIS FORM Go? To the same office which whichever is nat applicable) conducted the conciation, unless directed otherwise. ‘The issues in dispute ere later) 7. DETAILS OF PARTY REQUESTING ARBITRATION. Case Reference Number: was referred for concliaion but remains unresolved, ‘The certificate of non-resolution is attached /30 days have expired since referal (delete (Give a brie description. Te commissioner may requ @ mre deaied statement of ase SALGBC Case Number. Please tum over... APPROVED BY THE EXECUTIVE COMPITEE ON 20 JUNE 2028‘OTHER INSTRUCTIONS, ‘Acopy of his form must be served on the other party, Proof that a copy of this form has been served onthe other party must be supplied by attaching any of the following + Acopy of a registered sip from the Post Ofice; or » A copy of a signed receipt if hand delivered; oF + Assigned statement confirming sence by the person delivering the form; oF + Acopy of a fax or email confirmation slip or sent email; or = Any other satisfactory proof of service ‘The cerificate confirming that the dispute was unresolved through conciliation must also be attached to ths form Ia party does not want the ‘commissioner who conducted the coneiliation proceedings to aitrate this dispute that party ‘must filin LRA form 7.14 Check! Have you sent a copy of this ‘completed form tothe other party? Have you included proof that you have sent a copy tothe other party) with tis form? Have you allached the certificate confirming that the dispute was unresolved through conciliation? 3. NAME OF MUNICIPALITY: {if manicipol owned entity, the company or close corporation, the name ofthe MOE, company or cose corporation}: Contact person: Postal Address: Physical Address: Code: soos Coll Email: Tel: Fax: Number of employees employed by employer’ SECOND RESPONDENT Name(s): Contact person: . Postal Address: Code: Physical Address: Code: . cell: Email Tel Fax: 4.WHAT DECISION WOULD YOU LIKE THE COMMISSIONER TO MAKE: ‘The commissioner may requir a more detailed statement of case fete. 5, POPIA CONFIRMATION By signing this document, we hereby grant my voluntary consent that my/our personal information may be processed, collected, used and disclosed in compliance with the Protection of Personal Information Act, 4 of 2013. I/we furthermore agree that my/our personal information may be used for the lawful and reasonable purposes in as far as the SALGBC (responsible party) must use my/our information in the performance of its public legat duty. I/we understand that my/our personal information may be disclosed to a third party in as far as the SALGBC must fulfill its public legal duty. /we furthermore understand that there are instances in terms of the abovementioned Act where my express consent is not necessary to permit the processing of personal information, which may be related to litigation or when the information Is publicly available. ‘APPROVED BY THE EXECUTIVE COMMITTEE ON 20,UNEZ0Z¢6. CONFIRMATION OF ABOVE DETAILS: Form submitted by: (pleas print name) Signature... Position: Date: Place: This Form must be signed by the requesting party, or a person entitled to represent the party inthe arbitration proceedings. TRAFonm 713 [APPROVED BY THE EXECUTIVE COMMITTEE ON 20 JUNE 2028Request for Arbitration CONTACT DETAILS OF OFFICES OR DIVISIONS OF THE COUNCIL Head Office Tek: (081) 201-8210 E-mail nfo@salgbe.orgza Physical Address: 461 King Dinuzulo Rod (South), Durban, 4062 Gauteng Regional Office Gauteng Division Tek (012) 666.0249 Eat infog@saigbc.orgza Physical Address: 3 Einslein Stet, Highveld Techno Park, Centurion, Gauteng, 0187 Eastern Cape Regional Office Easlem Cape Division Tek (O41) 861-8222 (041) 581-3672 E-mail info eo@salgbe.org za Johannesburg Metropolitan Division Tshwane Metropolitan Division Tek: (atz) 985.0248 Tek (012) 665-0249 E-mail nfo g@salgbc.or922 Exmal: info g@salgbe.org.za Physical Address: 3 Einsein Steet, Highveld Physical Adsress: 3 Einstein Sto, Techno Patk, Centurion, Gauteng, 0157 Highveld Techno Park, Centurion, Gauteng, 0187 Physical Address: 38 Heugh Road, Walmer, Por Elizabeth, 6070 KwaZulu-Natal Regional Ofice eThekwini Metropolitan Division Tek, (031) 201-625 E-mail: iio ken@salobe org.za Physical Address: 461 King Dinuzulu Road (Gouth), Durban, 4062 Western Cape Regional Office ‘Westen Cape Division Tek (021) 917-1141 1213 E-mail: info mo@salgbe.19 28 Physical Adéress 7 De Villrs Street, Belvil, Cape Town, 7522 KwaZulu Nata Division Tet (031) 201-6295 Email nfo ken@salgbc org za Physical Address: 461 King Dinuzulu Road (South), Durban, 4062 Cape Town Meropottan Division eb: (021) 917-1141 2/3 E-ma info mo@salobe or. Physical Address: 7 De Viers trot, Belle, Cape Town, 7532, North WestMpumalanga/Limpopo Regional Office Mpumalanga Division Tek: (012) 342.428 Ermall: info g@sagbe.org.za Physical Address: 3 Einstein Sie Highveld Techno Park, Centurion, 0187 auteng Northern CapelFroe State Regional Otice Norther Cape Divison, Tet (053) 832-121516 E-mail: info s@salobe or ze Physical Address: 10 Holand Road, New Patk, Kimberley, 8300 North West Division Limpopo Division Tek: (012) 342-3428 Tol: (012) 342.3428 Exmal no.g@salgbe.org2a E-mat: nfo g@salabo.org.za Physical Address: 3 Eislcin Steet, HighveldTechno Physical Address: 3 Einstein Patk, Centurion, Gauteng, 0157 Steet, Highveld Techno Pask, Centurion, Gauteng, ots? Free State Division Tek (063) 832-1215 E-mal:nfo fs@salgbc.org.za Physical Address: 10 Holand Road, New Park, Kinberley, 8200, ‘APPROVED BY THE EXECUTIVE COMMITTEE ON 20 0NE 2028Page Lof 2 LRA Form 7.14 | Labour Relations Act, 1895, 136(3) SALGBC NOTICE OF OBJECTION TO ARBITRATION BY SAME COMMISSIONER | Read This First | WHAT IS THE PURPOSE OF THIS FORM? This form notifies the Council that ‘a party objects to @ commissioner who Is the same commissioner ‘who led the conciliation process. ‘WHO FILLS IN THIS FORM? Objecting party. [WHERE DOES THIS FORM GO? ‘The General Secretary or Regional Secretary, of the Councl, 2s applicable. OTHER INSTRUCTIONS A copy of this form must be served on the other party. Proof thata copy ofthis form has been served on the other party ‘must be supplied by attaching any of the following: ‘OA copy of the registered slip {rom the Post Office; or oA copy of the signed receipt if hand delivered; or ‘OA signed staternent confirming. service by the person Gelivering the form; or ‘oA copy of a fax or email confirmation slip or sent email; or ‘Any other satisfactory proof of service. 1 PARTY DETAILS Name:. Postal Address: Tel: Cell: . Email: Person dealing with application: DETAILS OF THE OTHER PARTY Name: Postal Address: Tel: Cell: Contact Person: OBJECTION DETAILS We .. (name) object to the commissioner ... (name) who conciliated the matter .. (name of dispute / matter) arbitrating the same dispute, Case Number we request the Council to appoint a different commissioner. [APPROVED BY THE EXECUTIVE COMMITTEE ON 20 UNE 2028 Therefore, Please turn over.IMPORTANT: This form must be submitted to ‘the Council within 7 days after the date of sue of the centfcate of outcome. Page 1of2 4, POPIA CONFIRMATION By signing this document, we hereby grant my voluntary consent that mylour personal information may be processed, collected, used and disclosed in compliance with the Protection of Personal Information Act, 4 of 2013. Uwe furthermore agree that my/our personal information may be used forthe lawful and reasonable purposes in so far as the ‘SALGBC (responsible party) must use mylour information in the performance ofits public legal duty. I/we understand that my/our personal information may be disclosed toa third party in as far as the SALGBC must fulfil its public legal duty. lwe further understand that there are instances in terms of the abovementioned Act where my express consent is not necessary to permit the procession of personal information, may be related to Itigation or when the information is publicly available, 5, CONFIRMATION OF ABOVE DETAILS Form submitted by (name)... Position:... Signed: Date: Place: Case Number: APPROVED BY THE EXECUTIVE CONMITTEE ON 20 ANE 2024LRA Form 7.15, Ra, 1995 5137 (2) SALGBC APPLICATION TO APPOINT SENIOR COMMISSIONER TO ARBITRATE Read This First | WHAT ISTHE PURPOSE OF THIS FORM? ‘This form is an application by @ party to appoint a Senior Commissioner to arbitrate, applicable to divisional disputes only. (WHO FILLS IN THIS FORM? A party to the dispute. [WHERE DOES THIS FORM GO? ‘The Regional Secretary, South African Local Government Bargaining Council (Councif), in the case of divisional disputes. OTHER INSTRUCTIONS ‘Two documents must be attached to this form: (2) A motivation; (0) Proof that a copy ofthis formhas been served on the other party must be supplied by attaching or any of the following: # Acopy of the registered slip from the Post Office; of + Acopy of the signed receipt if hand delivered; or + Assigned statement confirming service by the person delivering the form; # Acopy ofa fax or email confirmation sip or sent + Any other satisfactory proof of service. CHECK! Have you sent a copy of this completed form to the other party? Have you included proof (that you have sent a copy to the other party) with this form? Have you attached your motivation? See section 137(1}(3) of the Labour Relations Act, 1995, 1. APPLICATION I/we apply to the Council to appoint a Senior Commissioner to resolve the dispute which has the following case number: . 2. MOTIVATION Prepare a motivation which deals with the issues raised in Section 137 of the Act. Some of these issues are: the complexity of the dispute; © whether there are conflicting arbitration awards that are relevant to the dispute; ‘the public interest; the nature of the question of law raised by the dispute. 3.CONFIRMATION OF ABOVE DETAILS Form submitted by (name): Position: Signed:, Dati Case Number: ... ‘APPROVED BY THE EXECUTIVE COMMITTEE ON 20 UNE 2024LRA Form 7.16 4,399 '§142{1}(a)(0) and (c) Rule 37 of SALGBC Rul les SALGBC SUBPOENA ‘The following must be attached to request fora subpoena: (2) motivation for the application; and (©) proof that witness fees, traveling costs and subsistence expenses have been pad. This form, together with the motivation and proof of payment of witness travelling costs and subsistence expenses, must be submitted to the Council at least fourteen (14) days prior to the date of the arbitration hearin ‘Compliance with the 1B Protection of Personal Information Act 4 of 2013, ce ) fees, ‘The personal information that is recorded in this Subpoena may only be utilized for purposes set out in section 142{2) (a), (b) and (¢) of the Labour Relations SSALGBC Rule 37 act and Te (Name of Subpoenaed Person) (Designation of Subpoenaed Person) (Address of Subpoenaed Person) The South African Local Government Bargaining Council (SALGBC) has appointed a Commissioner to attempt to resolve a dispute in terms of the Labour Relations Act, 1995 (No. 66 of 1995) Commissioner appointed Bargaining Council Case number: The dispute is between (ame of Applicant) and (Name of Respondent) Issue of Dispute: You are required in terms of Section 142 of the Labour Relations Act 1995 to appear before ‘the Commissioner at: (Adress where the hearing being held) on at and any subsequent day(s) to which {Date of hearing) (Gime of heating) the proceedings may be postponed. You are subpoenaed: 1 For questioning in terms of Section 142(3)(a) 1D to produce any book, document, visual footage or object in terms of Section 142(1)(b) 1 to give expert evidence in terms of Section 142(2}(¢) (Tick appropriate block) APPROVED 8Y THE EXECUTIVE COMMITEE ON 20 INE 2024‘You must bring and produce the appropriate books, documents, visual footage or objects listed below: [List books, documents and objects) ‘The party requesting the subpoena has been directed to furnish you with the first day witness fees together with the reasonable travel expenses to attend the hearing. Signature of General Secretary/Deputy General Secretary/Legal & Compliance Manager / Regional Secretary: Date: Name: Place: [APPROVED BY THE EXECUTIVE COMMITTEE ON 20 AINE 2024Page lof4_ Form 7.19 SALGBC tnases REQUEST FOR INQUIRY BY Suse - ARBITRATOR Read This First 1. DETAILS OF PARTY REQUESTING AN INQUIRY Name: Postal Address. Code: .. WHO FILLS IN THIS FORM? ‘an employer requesting an | Physical Address... inquiry. In terms of section 188A (11), an employee who alleges that the holding of a disciplinary inquiry by an Tel: ‘employer contravenes the Protected Disclosures Act26 | Cell. of 2000, WHERE DOES THIS Postal Address... FORM GO? To the Regional Secretary of the Council in the division where the dispute arose. {See details attached) Physical Address. Code: Tel: cell 2, EMPLOYEE DETAILS Name: ‘Surname: Length of Service... 1D Number:., Salary Net:.. Salary Gros: Gender(M/F) .» Nationality:... Postal address:.... Fax: Tel: Cells... Email lease turn over. Case Number [APPROVED BY THE EXECUTE COMMITTEE ON 20 UNE 20243, ALLEGATIONS ABOUT CONDUCT OR CAPACITY Attach a copy of the allegations (charges) against the employee to this form ‘CONSENT 4, CONFIRMATION AND CONSENT TO INQUIRY ‘An inquiry by arbitrator |... os that is requested by the (Name of Employee) ‘employer may only be conducted with the consent of the employee, fr in accordance with a collective agreement, or | (a) ! consent to the process; or Where an employee | (b) Am bound bya collective agreement providing for the inquiry. A copy of the Confirm that | have been advised of the allegations against me; and | earning more than the collective agreement is attached; or threshold has consented | (c) 1 earn more than the threshold and have consented to the process in my to the holding of the contract of employment. A copy of the contract of employment is attached inquiry in a contract of hereto. employment. EMPLOYEE SIGNATURE FEES PAYABLE 5. PAYMENT OF FEES Proof of payment of the Prectrited tee’ "must | Proof of payment of the prescribed fee is attached accompany this form, Payment may only be made |G PLACE OF HEARING. by: i Oy spect electonic payment | Please select where you would prefer the inquiry to take place: into the SALGBC bank account. a) SALGBC Office |— b) Employer Premises [Pssst ccniect) the SALEDe c) Digital video conferencing platforms National or Regional Office for banking details. If you select employer premises, please provide physical address of employer's premises, Please turn over .. | [ease Number... ePROVED BY THEEXECUTIVE COMMITTEE ON20,1UNE 20247. INTERPRETER SERVICES Isan interpreter required at the inquiry? [Yes No | OTHER INSTRUCTIONS ‘A copy of this form has been | If yes, please indicate for what language: served on the ather party Proof that @ copy of this form hs De es i oes © Afrikaans GQ WsiNdebele GQ Isizulu—_isixhosa Sreahing one of te following. Q sepedi Sesotho Q Setswana O siSwati A copy of a registered sip Tshivanda OQ Xitsonga © Other (please indicate) from the Post Office; or + Acopy fs signed receiptif hand dellvereds of 8, COMPLIANCE WITH POPIA © A signed” statement confirming service by the Gerson delveringthe form, | BY signing this document, I/we hereby grant my voluntary consent that my/our personal 7 information may be processed, collected, used and disclosed in compliance with the + Acopy of the fax or email | Protection of Personal Information Act, 4 of 2033. I/we furthermore agree that my/our confirmation slip or sent e- | personal information may be used for the lawful and reasonable purposes in as far as the rail; or ‘SALGBC (responsible party) must use my/our information in the performance ofits public ‘s Anyother satisfactory legal duty, /we understand that my/our personal information may be disclosed to a third proof of service party in as far as the SALGBC must fulfill its public legal duty. I/we furthermore understand that there are instances in terms of the abovementioned Act where my express consent is rot necessary to permit the processing of personal information, which may be related to litigation of when the information is publicly available. 8.CONFIRMATION OF ABOVE DETAILS: Foam submited by: (lease print name} Signature: Position: Date: Place: ‘APPROVED BY THE EXECUTIVE COMMITTEE ON 20 RINE 2024CONTACT DETAILS OF OFFICES OR DIVISIONS OF THE COUNCIL Head Office Tet: (081) 201-8210 E-mal info@salghe org 2a Physical Adgtess: 46 King Dinuzulu Road (South), Durban, 4062 Gauteng Regional Ofice Gauieng Division Johannesburg Metropolitan Division Tehwane Metropottan Division Tok: (012) 865.0049 Tek (012) 665.0249 Tet: (012) 685.0249 E-mat info g@salghe.o9 za Ema info g@salgbe.orgza E-mall: info g@sagbo.org za Physical Adiress:3 Einsiein Steel, Physical Adress: 3 Einstein Set, Physical Aderess: 3 Einstein Steel, Highveld Highveld Techno Park, Centurion, Highveld Techno Park, Centurcn, Techno Patk, Centurion, Gauteng, 0157 Gauteng, 0157 Gauteng, 0157 Easter Cape Regional Otice Easter Cape Division Tek: (O41) 881-3222 / (041) $81-3672 E-mal info ec@salgbe.org.za Physical Address: 38 Heugh Road, Walmer , Pot Bizabath 6070, KwaZulu-Natal Regional Office «eThekwini Metopoltan Dision KwaZulu Natl Dison Tol: (031) 201-6205 Tek. (031) 201-6295 E-mal infoken@salgbc.orgza E:mat Infoxan@sagbe.orgza Physical Adéess: 461 King Diruzulu Physical Address: 461 King Dnuzuly Road (South), Durban, 4062 Road (South), Dutban, 4062 Western Cape Regional Office Wester Cape Division ‘Cape Town Metropaitan Division Tok (021) S17-1141 1213, Tek (021) 917-1141 (213 E-mal:nfome@salobc org za Ema infoc@salgbe 0 28 Physical Address: 7 De Villers Street, Physical Address: 7 De Villers Stes, Baile, Cape Town, 7532 Belvile, Cape Town, 7532 North WestiipumalangalLimpopo Regional Ofice Mpumalanga Division ‘Noh West Division Limpopo Division Tek: (012) 342-3428 Tek: (012) 3423428 Tek: (012) 342.3428 E-maliniog@salgboorg.z2 E-mal: nfo g@sagb. 01972 E-mal: nfo g@saigbc.oraza Physical Address: 3Einsicn Svoet, Physical Address: 3 Einslein Stoo, Highveld Physical Address: 3 Einstein Street, Highveld Highveld Techno Park, Centurion, Techno Patk, Centurion, Gauteng, 187 Techno Patk, Centurion, Gautng, 0187 Gauteng, 0187 Northern CapelFree State Regional Office Northern Cape Division Free Stale Division Tet: (053) 832121585 Tek (053) 832-421506 E-mall: ino fs@salabe.0g 2a E-mail infofs@salobe.o«g.za Physical Address: 10 Holland Read, Physical Address: 10 Holland Road, New Park, Kimberey, 6200 New Park, Kimberey, 8300 ‘APPROVED BY THE EXECUTIVE COMMITEE ON 20 JUNE 2026LRA Form 7.23 LRA 1995, $135 (24) Read This First WHAT IS THE PURPOSE OF ‘THIS FORM ‘This form is intended to request ertension of he 30-dayconcllation perio. WHO MAY APPLY FOR EXTENSION ‘The Commissioner of any of the parties tothe dispute may request | the Genera secretary or Nominee for Regional Secretary to extend the Conciiation period. where it i boieved that there ae prospects ot reaching a setlement FURTHER INFORMATION. ‘This Appliation must be served ‘onal relevant parties, No objection to the application wit! be considered. The fetenson ie considered on the basi the information provided bythe applicant. Supporting documents may be attached tthe form, ‘The application may only be ‘made where the partis can't ‘agree to an extension and the refusal to agree is considered Uuneeasonatie ‘The extension sought shall not cerceed 5 days | Al the information required in this form must be completed Page 2of2 | SALGBC | APPLICATION FOR EXTENSION OF THE CONCILIATION PERIOD - | Employee or Trade Union Party. Employer Party: Nature of Dispute: ... Date of Referral: Date of Conciliation: Number of days extension required: Has the other party refused to extend the conciliation period: Ci ves = [Jno Ino, glve reasons why the refusal is considered unreasonable ‘Are there prospects of reaching a settlement ifthe conciliation is extended: CI ve [) No If yes, provide reasons Provide any other submissions that may be relevant to the request for extension | Applicant: Signature of requesting party: Date of Request: . PLEASE TURN OVER. SALGBC CASE NUMBE ‘Application for Extension ofthe Conciliation Period APPROVED BY THE EXECUTIVE COMMITTEE ON 20 UNE 2024Page 2of2 [| Application granted "Number of days for which the conciliation is extended Reasons and/or Conditions attached to the extension: [| Application rejected Reasons for rejection General Secretary or Nominee (Or Regional Secretary Date APPROVED BY THE EXECUTIVE COMMITTEE ON20 UNE 2024 PART B: GENERAL SECRETARY or NOMINEE or REGIONAL SECRETARY‘SALGEC Form SALGBC SETTLEMENT AGREEMENT LRA, 1995 In the dispute between SALGBC Case No. Applicant/s .. ‘And Respondent/s .. THE UNDERSIGNED PARTIES RECORD THE SETTLEMENT OF THEIR DISPUTE, IN FULL AND FINAL ‘SETTLEMENT, IN THE FOLLOWING TERMS: 1 The employer agrees to reinstate/re-employ the employee with effect from on same terms and conditions of employment as existed prior to the dismissal. 2. The employer agrees to pay the employee the sum of R_ __as follows: In full payment on or before /. (date) In installments payable as follows: R on R on R on R on R on R on Method of payment: [-_] cash/cheque to be collected by employee at __ employer's premises. Payment will be deposited into the employee's bank account. 3 Other: 4. The parties agree that this isin full and final settlement of the said dispute and that no variat of this agreement will be legally binding unless reduced to writing. 5. In the event of the employer failing to comply with its obligations in terms of this agreement, the employer, in terms of 142 A (1) of the LRA, consents to this agreement being made an arbitration award. ‘THIS DONE AND SIGNED AT. on DAY OF 20__ APPLICANT RESPONDENT PRESIDING COMMISSIONER WITNESSES NB: The format ofthis settlement agreement is a guideline only, The parties to the settlement agreement must ensure that the terms and concitions oftheir settlement are properly recorded, APPROVED BY THE EXECUTIVE COMMITTEE ON 20,UNE 2024SALGBC APPLICATION IN TERMS OF S142A IN THE SOUTH AFRICAN LOCAL GOVERNMENT BARGAINING COUNCIL (SALGBC) HELD AT SALGBC CASE NO. In the matter between: Applicant(s) and Respondent(s) NOTICE OF APPLICATION To: The Regional / General Secretary or Nominee SALGBC And to: ____tRespondent) ——————e —tadaress) (Address! ion on a date to be Take notice that the above-named applicant(s) will make appli determined by the SALGBC for an order in the following terms: 1, That the annexed settlement agreement entered into between the abovementioned parties be made an arbitration award in terms of section 142A. Take further notice that the affidavit or written statement of the applicant, annexed hereto, will be used in support of this application. Take further notice that if the respondent wishes to oppose the application, it must deliver an answering affidavit or written statement within 10 working days from the day ‘on which this application was served on the respondent, failing which the matter may be heard in the respondent's absence. Take further notice that the applicant has appointed the address below at which notices and service of all documents and proceedings will be accepted. Dated at ___this__day of 0. Applicant's Address: Applicant's Signature APPROVED BY THE EXECUTIVE COMMITTEE ON 20 JUNE 2024SALGBC APPLICATION IN TERMS OF S142A SALGBC CASE NO. : Applicants) and Respondent(s) AFFIDAVIT |, the undersigned, (full name of Applicant) do hereby make oath and say: 1. Background 1.1. The settlement agreement annexed hereto and marked “A” was concluded between the parties on (date). 1.2. The settlement agreement is in respect of a dispute that a party has the right to refer to arbitration or to the Labour Court, excluding a dispute that a party has the right to refer to arbitration in terms of section 74(4) or 75(5). 1.3. The dispute in respect of which the settlement agreement was concluded was referred for conciliation on (date) under case number 1.4. The parties have not agreed to the settlement agreement being made an arbitration award. 2, Reasons (EG. One party filed to comply with its obligations in terms ofthe agreement) APPROVED BY THE EXECUTE COMMITTEE ON 20 JUNE 2024Applicant's signature Signed before me on at by the deponent who acknowledges that he/she knows and understands the contents of the affidavit, has no objection to taking the oath/affirmation and considers it binding on his/her conscience. Commissioner of Oaths: Name : _ Address Capacity [APPROVED BY THE EXECUTIVE COMMITTEE ON 20,UNE 2024SALGBC APPLICATION IN TERMS OF S142A SALGBC CASE NO. Applicani(s) and Respondent(s) WRITTEN STATEMENT I, the undersigned, oe (full name of Applicant do hereby declare that the following information is accurate and that | understand that | may be required to confirm the content of this written statement under oath or affirmation before @ commissioner of the SALGBC. 1, Background 1.1, The settlement agreement annexed hereto and marked “A” was concluded between the parties on _ (date). 1.2. The settlement agreement is in respect of a dispute that a party has the right to refer to arbitration or to the Labour Court, excluding a dispute that a party has the right to refer to arbitration in terms of section 74(4) or 75(5). 1.3. The dispute in respect of which the settlement agreement was concluded was referred for conciliation on (date) under case number 1.4. The parties have not agreed to the settlement agreement being made an arbitration award. [APPROVED BY THE EXECUTIVE COMMITTEE ON 20 JUNE 20242. Reasons (EG. One pary fale to comply with is obligations in terms of the agreement) Applicant's signature APPROVED BY THE EXECUTIVE COMMITTEE ON 20,UNE 2024Section 144 of the Labour Relations Act 66 of 1995 SALGBC APPLICATION FOR RESCISSION OF AN ARBITRATION AWARD OR A RULING PLEASE READ THIS: The — grounds for ‘escssion or variation are set out under the Written Statement or Affidavit section ofthis application form. ] I instRucTiON Service and filing A copy ofthis completed IDENTIFYING DETAILS Name of party applying for rescission (iit is on employer, please cite the full name of the ‘municipality orn the ease of @ natural person, thot person's name and surname) application form must be served on the other party by means of e-mail, registered mail, hand elivery, or any other means 2 set out in SSALGRC Rule 3. Contact number and Email ‘A copy of the application form must be filed with the SALGBC within 14- | days ofthe date on which | the applicant became aware of the award or ruling. Proof of service on the other party must be attached tothe Name of the respondent (ifts on employer, please cite the fullname ofthe municipality or In the cose ofa natura person, that person's name and surnome) application form, The other party has 5 ays in which to oppose the application, after Wich the applicant has 3 ays to respond to the opposing statement or atfidavt, Condonation Fallure to comply with the above time periods Contact Person, Contact number and e-mail address (e.g name and surname of HR or ER representative for SALGBC disputes against the employer or name and surname of union representative if the employee is represented by a union) will require an | Case number application for condonation. APPROVED BY THE EXECUTIVE COMMITTEE ON 20.,INE 2024 Page 1 of 4‘Section 144 of the LRA 66 (1985 (the LRA) provides that WRITTEN STATEMENT Any commissioner who has Issued an arbitration award for ling, or anyother commissioner appointed by ‘he General Secretary of Nominge or Regal Secretary for that purpose, ‘may on that commisioner's own accord or, on the pplation of any affected ary, vary or rescind an srbiration award or ruling— () erroneously sought or ‘erroneously made inthe fapeenes of any party aifected by that award; (&) whieh there is an ambiguity, or an obvious feror or omission, but nly tothe extent of that ambiguity erroror ©) granted as 2 result of 2 rnistke common to the pares the prootedings: oF {€) made inthe absence of ‘ny party, on good cause shown Please note that a fammisioner may requlre ‘hat you confirm the content of your writen statement Under oxth or atimation, |, the undersigned, (fall name of person making the written statement) do hereby declare that the following information is accurate and that | understand that | may be required to confirm the content of this written statement under oath or affirmation before a commissioner of the SALGBC. I hereby apply for the rescission / variation (please select the relevant option) of the ruling/arbitration award (please select the relevant option) rendered by Commissioner on. became aware of the ruling/arbitration award (please select the relevant option) on date. ‘The grounds for this application are set out below: Signature of Applicant or duly authorised representative APPROVED BY THE EXECUTIVE COMMITTEE ON 20)UNE2024 Page 20f4Section 148 oF the LRA 65 lof 1995 {the LRA) provides AFFIDAVIT that ‘ny commissioner who has Issued an arbitration award | | the undersigned, oF lng, anyother | fullname of person moking the writen stotement) ‘commissioner appointed by | the, "Geneol Seretry or Nominee or Regional do hereby declare that the following information is accurate and that | understand that | | Secretory fr tat pupose, may be required to confirm the content of this written statement under oath or affirmation ‘rayon tay commisore'® before a commissioner of the SALGBC. Soliton of ny aces far. wart iit! 3" | hereby apply for the rescission / variation (please select the relevant option) of the| ruling/arbitration award (please select the relevant option) rendered by (2) erroneously sought or terroneouslymade inthe | Commissioner on. date. fbsence of any pany TT flected by that award; (0) in which there ie an ambjgutycr an obvovs | | became aware of the r. ‘only tothe extent ofthat date ambiguity eeor oF —_——__ ar comission; \g/arbitration award (pleose select the relevant option) on The grounds for this application are set out below: (eh arames as 3 rest of @ mistake common 0 the partes tothe proceetings or (3) mate ne absence of | yaar ongeedcae | ‘APPROVED BY THE EXECUTIVE COMATTEE ON 70I0NE 2028 Page 3 of 4Please note that fommisioner may require that you conf the content of yourafidavitundereathor affrmation | Signed before me on at by) the deponent who acknowledges that he/she knows and understands the contents of the affidavit, has no objection to taking the oath/affirmation and considers it binding on his/her’ conscience, Commissioner of Oaths Name : — | Address Capacity | POPIA CONFIRMATION By signing this document, I/we hereby grant my voluntary consent that my/our personal information may be processed, collected, used and disclosed in compliance with the Protection of Personal Information Act, 4 of 2013. I/we furthermore agree that my/our personal information may be used for the lawful and reasonable purposes in as far as the SALGBC (responsible party) must use my/our information in the performance of its public legal duty. |/we understand that my/our personal information may be disclosed toa third party in as far as the SALGBC must fulfill its public legal duty. I/we furthermore understand that there are instances in terms of the abovementioned Act where my express consent is not necessary to permit the processing of personal information, which ‘may be related to litigation or when the information is publicly available, Page 4 of &