Jan. 13.] THE NEW ZEALAND GAZETTE. 13

(Secs. 17 and 26.)
[Form I.C. 2B.
Under the Industrial Conciliation and Arbitration Act, 1925.
ANNUAL RETURN OF OFFICERS, TRUSTEES, AUDITORS, AND MEMBERS OF THE INDUSTRIAL ASSOCIATION OF AS ON THE 31ST DECEMBER, 19 .

Number of unions constituting association :
Situation of registered office of association :

STATUTORY DECLARATION.

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 association].
(2.) That the above is a full and correct statement of the names, addresses, and occupations of the officers, trustees, and auditors of the association and of the number of unions affiliated with the association whose subscriptions were not more than twelve months in arrear 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 , 19 ,
before me—

[Signature.]

Justice of the Peace [or Solicitor].

—

(Secs. 22 and 26.)
[Form I.C. 3A.
Under the Industrial Conciliation and Arbitration Act, 1925.
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 under the above-mentioned Act 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 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].

—

(Sec. 29.)
[Form I.C. 4A.
Under the Industrial Conciliation and Arbitration Act, 1925.
NOTICE OF CONCURRENCE WITH INDUSTRIAL AGREEMENT.

To the Clerk of Awards at .

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

Dated at , this day of , 19 .

[Signature.]

(Secs. 41 and 108.)
[Form I.C. 5A.
Under the Industrial Conciliation and Arbitration Act, 1925.
APPLICATION THAT INDUSTRIAL DISPUTE BE HEARD BY A COUNCIL OF CONCILIATION.

In the matter of the Industrial Conciliation and Arbitration Act, 1925.

Between and .

To the Clerk of Awards 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 dispute should be heard by a Council of Conciliation, application is hereby made, in pursuance of section 41 of the Industrial Conciliation and Arbitration Act, 1925, 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 applicant[s] ”).

(2.) It is desired that [Names of industrial unions, associations, or employers] (hereinafter referred to as “ the respondent[s] ”) be made party to the proceedings.

(3.) The following is a general statement of the nature of the dispute and a schedule of the claims made by the applicant[s] against the respondent[s]. [Set out a detailed statement of such claims].

(4.) The applicant[s] propose[s] that one [or two, or three] assessor[s] sit with the Commissioner on behalf of the applicant[s] in the hearing and settlement of the said dispute, and recommend[s] the following persons as assessors [Names, occupations, and addresses of proposed assessors].

(5.) [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 by secret ballot at a special meeting of the union, a majority of the members present at the said meeting voting in favour thereof. A certificate 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 hereto attached.

Dated at , this day of , 19 .

[Signatures.]

(Sec. 58.)
[Form I.C. 5B.
Under the Industrial Conciliation and Arbitration Act, 1925.
APPLICATION THAT INDUSTRIAL DISPUTE AFFECTING TWO OR MORE INDUSTRIAL DISTRICTS BE HEARD BY A COUNCIL OF CONCILIATION.

In the matter of the Industrial Conciliation and Arbitration Act, 1925.

Between and .

To the Clerk of Awards at .

WHEREAS an industrial dispute relating to two or more industrial districts, that is to say, the industrial districts of , has arisen between [Name of applicant(s)] and [Name of respondent[s], and it is expedient that the dispute should be heard by a Council of Conciliation, application is hereby made, in pursuance of section 58 of the Industrial Conciliation and Arbitration Act, 1925, that the said dispute should be so heard.

(1.) This application is made by [Name of applicant(s)] (hereinafter referred to as “ the applicant[s] ”).

(2.) It is desired that [Names of respondent[s]] (hereinafter referred to as “ the respondent[s] ”) be made party to the proceedings.

(3.) The following is a general statement of the nature of the dispute and a schedule of the claims made by the applicant[s] against the respondent[s]. [Set out a detailed statement of such claims].

(4.) The applicant[s] propose[s] that one [or two, &c., up to six] assessor[s] sit with the Commissioner on behalf of the applicant[s] in the hearing and settlement of the said dispute, and recommend[s] the following persons as assessors: [Names, occupations, and addresses of proposed assessors].

(5.) This application has been approved by the members of each of the unions concerned by a resolution passed by secret ballot at a special meeting of the union, a majority of the members present at the said meeting voting in favour thereof. A certificate under the hand of the chairman 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 hereto attached.

Dated at , this day of , 19 .

[Signatures.]