1904
THE NEW ZEALAND GAZETTE
[No. 52]

(Secs. 17 and 23.)
Form I.C. 2c.
Under the Industrial Conciliation and Arbitration Act, 1908, and its Amendments.

STATUTORY DECLARATION AS TO YEARLY LIST OF MEMBERS AND OFFICERS OF INDUSTRIAL UNION [OR ASSOCIATION].

I, [Name in full], of [Address and occupation], do solemnly and sincerely declare as follows :—

(1.) That I am the chairman [or secretary] of the [Full name of union or association].

(2.) (a.) Union.—That the list hereto annexed and marked “A” is a full and correct list of the members of the said union, whose subscriptions are not more than twelve months in arrear, and of the officers (including trustees) of that union, as on the 31st day of December, 19

Or (2.) (b.) Association.—That the list hereto annexed and marked “A” is a full and correct list of the industrial unions constituting the said association, and of the officers (including trustees) thereof, as on the 31st day of December, 19

And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the Justices of the Peace Act, 1908.

Declared at __, this __ day of January, 19 __, before me,—

Justice of the Peace [or Solicitor].

(Secs. 21 and 23.)
Form I.C. 3A.
Under the Industrial Conciliation and Arbitration Act, 1908, and its Amendments.

APPLICATION FOR CANCELLATION OF REGISTRATION OF INDUSTRIAL UNION [OR ASSOCIATION].

To the Registrar of Industrial Unions, Wellington.

We hereby make application for the cancellation of the registration of the [Registered name of the industrial union or association].

We enclose herewith,—

(a.) The certificate of registration.

(b.) Evidence that cancellation is desired by a majority of the members of the said union [or by a majority of the unions constituting the said association].

1. Total present membership :

2. Number present at meeting :

3. Number voting in favour of cancellation :

Dated at __, this __ day of __, 19 __.

[To be signed by two or more officers.]

of the said industrial union [or association].

of the said industrial union [or association].

[Seal.]

(Sec. 27.)
Form I.C. 4A.
Under the Industrial Conciliation and Arbitration Act, 1908, and its Amendments.

NOTICE OF CONCURRENCE IN INDUSTRIAL AGREEMENT.

To the Clerk of Awards at

Take notice that I [Name in full, address, and occupation], being an employer of workers in [Specify industry], hereby signify my concurrence [or Take notice that the Industrial Union (or Association), of __, hereby signifies its concurrence] in the industrial agreement dated the __ day of __, between __ and __, and filed in your office as No. __.

Dated at __, this __ day of __, 19 __.

[Signatures and seals.]

(Am. Act, 1908, sec. 30 ; Prin. Act, sec. 107.)
Form I.C. 5A.
Under the Industrial Conciliation and Arbitration Act, 1908, and its Amendments.

APPLICATION THAT INDUSTRIAL DISPUTE BE HEARD BY A COUNCIL OF CONCILIATION.

To the Conciliation Commissioner at

Whereas an industrial dispute has arisen between [Name of industrial union or association of workers] and [Name of employer or employers, or of industrial union or association of employers], and it is expedient that the same should be heard by a Council of Conciliation, application is hereby made, in pursuance of section 30 of the Industrial Conciliation and Arbitration Amendment Act, 1908, that the said dispute should be so heard.

(1.) This application is made by [Name of union, association, or employer making the application] (hereinafter referred to as “the applicants”).

(2.) It is desired that [Names of industrial unions, associations, or employers] (hereinafter referred to as “the respondents”) be made parties to the proceedings in the matter of the said dispute.

(3.) The following is a general statement of the nature of the dispute [Describe dispute].

(4.) The applicants make the following claims against the respondents in the matter of the said dispute [Set out a detailed statement of such claims].

(5.) The applicants recommend that one [or two, or three] assessor[s] sit with the Commissioner in the hearing and settlement of the said dispute.

(6.) The persons so recommended as assessors are [Names, occupations, and addresses of proposed assessors].

(7.) [Where application is made by a union or association add] This application has been approved by the members of the union [or of each of the unions concerned] by a resolution passed at a special meeting of the union and confirmed by a subsequent ballot of the members, a majority of the votes recorded being in favour thereof, and the result of such ballot has been recorded in the minutes of the said meeting. A certificate [or Certificates] under the hand of the chairman of the said meeting [or of each of the said meetings] that the said meeting was properly constituted and held, and setting forth the nature of the proposal submitted at that meeting and the result of the voting thereon, is [are] hereto attached.

Dated at __, this __ day of __, 19 __.

[Signatures.]

(Sec. 107.)
Form I.C. 5B.
Under the Industrial Conciliation and Arbitration Act, 1908, and its Amendments.

BALLOT-PAPER FOR REFERENCE OF INDUSTRIAL DISPUTE FOR SETTLEMENT.

RESOLUTION.

At a special meeting of the __ Industrial Union of __, held on the __ day of __, 19 __, of which you have had due notice, the following resolution was passed [Here set out resolution].

It is required by the Act that the resolution be confirmed by a subsequent ballot of the members, and accordingly you are now requested to record your vote for or against the proposal in the following manner :—

If you are in favour of the above resolution strike out the word “No” opposite;

or

If you are not in favour of the above resolution strike out the word “Yes” opposite.

N.B.—This ballot-paper should be returned to the undersigned on or before the __ day of __, 19 __.

____, Secretary.
[Address.]
[Date.]

(Sec. 107.)
Form I.C. 5C.
Under the Industrial Conciliation and Arbitration Act, 1908, and its Amendments.

CERTIFICATE OF CHAIRMAN OF UNION FOR REFERENCE OF INDUSTRIAL DISPUTE FOR SETTLEMENT.

In the matter of an industrial dispute between __, applicant, and __, respondent, and of a reference thereof for settlement.

This is to certify—

1. That I, __, presided at a special meeting of the __ Industrial Union of __, duly constituted and convened in manner provided by the rules of the said union, and held on the __ day of __, 19 __.

2. That the meeting was convened by circular (or as the case may be), a copy of which is attached hereto, marked “A,” and a copy of which was posted to each member of the said union.

3. That the following resolution was passed at the said meeting [Set out resolution].

4. That a copy of the said resolution, with ballot-paper for confirmation or otherwise (a copy of which is attached hereto, marked “B”), was posted to each member of the said union on the __ day of __, 19 , returnable on or before the ____ day of __, 19 __.

5. That the result of the ballot was the confirmation of the said resolution, __ voting for and __ against such confirmation.

6. That the result of the ballot has been recorded in the minutes of the said union.

Dated at __, this __ day of __, 19 __.

____, Chairman.