Please ensure that you fill in valid email addresses where applicable.

Identification Details

    Please ensure that you enter the correct age (18 or above) in the field below.

    Main Contact Details

    Please ensure that you enter one 10-digit cell number in the field below.

    Alternative Contact Details

    Go To Next Section
    WHAT IS THE PURPOSE OF THIS FORM?
    This form enables a person or organisation to refer a dispute to the CCMA for conciliation and con-arb.

    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 Registrar, Regional Office of the CCMA 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.
    You may also need to deal with the dispute in terms of a private procedure if one applies. If in doubt contact the CCMA for assistance.

    WHAT WILL HAPPEN WHEN THIS FORM IS SUBMITTED?
    When you refer the dispute to the CCMA, it will appoint a commissioner who must attempt to resolve the dispute within 30 days.

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


    UNFAIR LABOUR PRACTICE
    If the dispute(s) concerns an unfair labour practice the dispute must be referred (i.e. received by the CCMA) 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.

    NATIONAL MINIMUM WAGE DISPUTES
    Disputes emanating from the NMWA and referred either in terms of s4(6) of the NMWA or s73A of the BCEA may be referred by any person who works for another and who receives or is entitled to receive any payment for that work.

    MUTUAL INTEREST DISPUTES
    • Attach the collective agreement on picketing; or
    • If no collective agreement on picketing, complete Annexure A to this form.
    • If referring a request for establishment of picketing rules, complete Annexure A to this form.
    • If referring a dispute relating to breach or interpretation of picketing rules, attach a copy of the picketing rules.


    DISPUTES RELATING TO COMPLIANCE ORDERS
    If referring a dispute relating to a compliance order, the order must be attached to this form. If the dispute is referred after the date on which compliance was due to you are required to apply for condonation.

    LEGISLATION REFERENCES
    • Labour Relations Act, 1995 Sections 9, 16, 21, 22, 24, 26, 45, 61, 63, 64, 72, 74,86, 89, 94, 134, 191(1), 198 and 198A-C.
    • Employment Equity Act, 1998 Section 10.
    • Basic Conditions of Employment Act, 1997 Sections 41, 69(5), 73A, 80, 84.
    • Skills Development Act, 1998 Section 19.
    • National Minimum Wage Act, 2018 Section 4(8).
    Please ensure that you fill in valid email addresses where applicable.

    Identification Details

      Contact Details

      Please ensure that you enter one 10-digit cell number in the field below.
      Back Go To Next Section
      WHAT IS THE PURPOSE OF THIS FORM?
      This form enables a person or organisation to refer a dispute to the CCMA for conciliation and con-arb.

      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 Registrar, Regional Office of the CCMA 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.
      You may also need to deal with the dispute in terms of a private procedure if one applies. If in doubt contact the CCMA for assistance.

      WHAT WILL HAPPEN WHEN THIS FORM IS SUBMITTED?
      When you refer the dispute to the CCMA, it will appoint a commissioner who must attempt to resolve the dispute within 30 days.

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


      UNFAIR LABOUR PRACTICE
      If the dispute(s) concerns an unfair labour practice the dispute must be referred (i.e. received by the CCMA) 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.

      NATIONAL MINIMUM WAGE DISPUTES
      Disputes emanating from the NMWA and referred either in terms of s4(6) of the NMWA or s73A of the BCEA may be referred by any person who works for another and who receives or is entitled to receive any payment for that work.

      MUTUAL INTEREST DISPUTES
      • Attach the collective agreement on picketing; or
      • If no collective agreement on picketing, complete Annexure A to this form.
      • If referring a request for establishment of picketing rules, complete Annexure A to this form.
      • If referring a dispute relating to breach or interpretation of picketing rules, attach a copy of the picketing rules.


      DISPUTES RELATING TO COMPLIANCE ORDERS
      If referring a dispute relating to a compliance order, the order must be attached to this form. If the dispute is referred after the date on which compliance was due to you are required to apply for condonation.

      LEGISLATION REFERENCES
      • Labour Relations Act, 1995 Sections 9, 16, 21, 22, 24, 26, 45, 61, 63, 64, 72, 74,86, 89, 94, 134, 191(1), 198 and 198A-C.
      • Employment Equity Act, 1998 Section 10.
      • Basic Conditions of Employment Act, 1997 Sections 41, 69(5), 73A, 80, 84.
      • Skills Development Act, 1998 Section 19.
      • National Minimum Wage Act, 2018 Section 4(8).

      Nature Of Dispute

      Facts Of Dispute Summary

      Fairness Of Dismissal

      Expected Outcomes

      Back Go To Next Section
      This section must be completed!
      This section must be completed!
      WHAT IS THE PURPOSE OF THIS FORM?
      This form enables a person or organisation to refer a dispute to the CCMA for conciliation and con-arb.

      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 Registrar, Regional Office of the CCMA 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.
      You may also need to deal with the dispute in terms of a private procedure if one applies. If in doubt contact the CCMA for assistance.

      WHAT WILL HAPPEN WHEN THIS FORM IS SUBMITTED?
      When you refer the dispute to the CCMA, it will appoint a commissioner who must attempt to resolve the dispute within 30 days.

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


      UNFAIR LABOUR PRACTICE
      If the dispute(s) concerns an unfair labour practice the dispute must be referred (i.e. received by the CCMA) 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.

      NATIONAL MINIMUM WAGE DISPUTES
      Disputes emanating from the NMWA and referred either in terms of s4(6) of the NMWA or s73A of the BCEA may be referred by any person who works for another and who receives or is entitled to receive any payment for that work.

      MUTUAL INTEREST DISPUTES
      • Attach the collective agreement on picketing; or
      • If no collective agreement on picketing, complete Annexure A to this form.
      • If referring a request for establishment of picketing rules, complete Annexure A to this form.
      • If referring a dispute relating to breach or interpretation of picketing rules, attach a copy of the picketing rules.


      DISPUTES RELATING TO COMPLIANCE ORDERS
      If referring a dispute relating to a compliance order, the order must be attached to this form. If the dispute is referred after the date on which compliance was due to you are required to apply for condonation.

      LEGISLATION REFERENCES
      • Labour Relations Act, 1995 Sections 9, 16, 21, 22, 24, 26, 45, 61, 63, 64, 72, 74,86, 89, 94, 134, 191(1), 198 and 198A-C.
      • Employment Equity Act, 1998 Section 10.
      • Basic Conditions of Employment Act, 1997 Sections 41, 69(5), 73A, 80, 84.
      • Skills Development Act, 1998 Section 19.
      • National Minimum Wage Act, 2018 Section 4(8).
      Back Go To Next Section
      This section must be completed!
      WHAT IS THE PURPOSE OF THIS FORM?
      This form enables a person or organisation to refer a dispute to the CCMA for conciliation and con-arb.

      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 Registrar, Regional Office of the CCMA 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.
      You may also need to deal with the dispute in terms of a private procedure if one applies. If in doubt contact the CCMA for assistance.

      WHAT WILL HAPPEN WHEN THIS FORM IS SUBMITTED?
      When you refer the dispute to the CCMA, it will appoint a commissioner who must attempt to resolve the dispute within 30 days.

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


      UNFAIR LABOUR PRACTICE
      If the dispute(s) concerns an unfair labour practice the dispute must be referred (i.e. received by the CCMA) 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.

      NATIONAL MINIMUM WAGE DISPUTES
      Disputes emanating from the NMWA and referred either in terms of s4(6) of the NMWA or s73A of the BCEA may be referred by any person who works for another and who receives or is entitled to receive any payment for that work.

      MUTUAL INTEREST DISPUTES
      • Attach the collective agreement on picketing; or
      • If no collective agreement on picketing, complete Annexure A to this form.
      • If referring a request for establishment of picketing rules, complete Annexure A to this form.
      • If referring a dispute relating to breach or interpretation of picketing rules, attach a copy of the picketing rules.


      DISPUTES RELATING TO COMPLIANCE ORDERS
      If referring a dispute relating to a compliance order, the order must be attached to this form. If the dispute is referred after the date on which compliance was due to you are required to apply for condonation.

      LEGISLATION REFERENCES
      • Labour Relations Act, 1995 Sections 9, 16, 21, 22, 24, 26, 45, 61, 63, 64, 72, 74,86, 89, 94, 134, 191(1), 198 and 198A-C.
      • Employment Equity Act, 1998 Section 10.
      • Basic Conditions of Employment Act, 1997 Sections 41, 69(5), 73A, 80, 84.
      • Skills Development Act, 1998 Section 19.
      • National Minimum Wage Act, 2018 Section 4(8).
      Back Go To Next Section
      WHAT IS THE PURPOSE OF THIS FORM?
      This form enables a person or organisation to refer a dispute to the CCMA for conciliation and con-arb.

      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 Registrar, Regional Office of the CCMA 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.
      You may also need to deal with the dispute in terms of a private procedure if one applies. If in doubt contact the CCMA for assistance.

      WHAT WILL HAPPEN WHEN THIS FORM IS SUBMITTED?
      When you refer the dispute to the CCMA, it will appoint a commissioner who must attempt to resolve the dispute within 30 days.

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


      UNFAIR LABOUR PRACTICE
      If the dispute(s) concerns an unfair labour practice the dispute must be referred (i.e. received by the CCMA) 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.

      NATIONAL MINIMUM WAGE DISPUTES
      Disputes emanating from the NMWA and referred either in terms of s4(6) of the NMWA or s73A of the BCEA may be referred by any person who works for another and who receives or is entitled to receive any payment for that work.

      MUTUAL INTEREST DISPUTES
      • Attach the collective agreement on picketing; or
      • If no collective agreement on picketing, complete Annexure A to this form.
      • If referring a request for establishment of picketing rules, complete Annexure A to this form.
      • If referring a dispute relating to breach or interpretation of picketing rules, attach a copy of the picketing rules.


      DISPUTES RELATING TO COMPLIANCE ORDERS
      If referring a dispute relating to a compliance order, the order must be attached to this form. If the dispute is referred after the date on which compliance was due to you are required to apply for condonation.

      LEGISLATION REFERENCES
      • Labour Relations Act, 1995 Sections 9, 16, 21, 22, 24, 26, 45, 61, 63, 64, 72, 74,86, 89, 94, 134, 191(1), 198 and 198A-C.
      • Employment Equity Act, 1998 Section 10.
      • Basic Conditions of Employment Act, 1997 Sections 41, 69(5), 73A, 80, 84.
      • Skills Development Act, 1998 Section 19.
      • National Minimum Wage Act, 2018 Section 4(8).
      Back Go To Next Section
      WHAT IS THE PURPOSE OF THIS FORM?
      This form enables a person or organisation to refer a dispute to the CCMA for conciliation and con-arb.

      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 Registrar, Regional Office of the CCMA 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.
      You may also need to deal with the dispute in terms of a private procedure if one applies. If in doubt contact the CCMA for assistance.

      WHAT WILL HAPPEN WHEN THIS FORM IS SUBMITTED?
      When you refer the dispute to the CCMA, it will appoint a commissioner who must attempt to resolve the dispute within 30 days.

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


      UNFAIR LABOUR PRACTICE
      If the dispute(s) concerns an unfair labour practice the dispute must be referred (i.e. received by the CCMA) 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.

      NATIONAL MINIMUM WAGE DISPUTES
      Disputes emanating from the NMWA and referred either in terms of s4(6) of the NMWA or s73A of the BCEA may be referred by any person who works for another and who receives or is entitled to receive any payment for that work.

      MUTUAL INTEREST DISPUTES
      • Attach the collective agreement on picketing; or
      • If no collective agreement on picketing, complete Annexure A to this form.
      • If referring a request for establishment of picketing rules, complete Annexure A to this form.
      • If referring a dispute relating to breach or interpretation of picketing rules, attach a copy of the picketing rules.


      DISPUTES RELATING TO COMPLIANCE ORDERS
      If referring a dispute relating to a compliance order, the order must be attached to this form. If the dispute is referred after the date on which compliance was due to you are required to apply for condonation.

      LEGISLATION REFERENCES
      • Labour Relations Act, 1995 Sections 9, 16, 21, 22, 24, 26, 45, 61, 63, 64, 72, 74,86, 89, 94, 134, 191(1), 198 and 198A-C.
      • Employment Equity Act, 1998 Section 10.
      • Basic Conditions of Employment Act, 1997 Sections 41, 69(5), 73A, 80, 84.
      • Skills Development Act, 1998 Section 19.
      • National Minimum Wage Act, 2018 Section 4(8).
      Back
      WHAT IS THE PURPOSE OF THIS FORM?
      This form enables a person or organisation to refer a dispute to the CCMA for conciliation and con-arb.

      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 Registrar, Regional Office of the CCMA 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.
      You may also need to deal with the dispute in terms of a private procedure if one applies. If in doubt contact the CCMA for assistance.

      WHAT WILL HAPPEN WHEN THIS FORM IS SUBMITTED?
      When you refer the dispute to the CCMA, it will appoint a commissioner who must attempt to resolve the dispute within 30 days.

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


      UNFAIR LABOUR PRACTICE
      If the dispute(s) concerns an unfair labour practice the dispute must be referred (i.e. received by the CCMA) 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.

      NATIONAL MINIMUM WAGE DISPUTES
      Disputes emanating from the NMWA and referred either in terms of s4(6) of the NMWA or s73A of the BCEA may be referred by any person who works for another and who receives or is entitled to receive any payment for that work.

      MUTUAL INTEREST DISPUTES
      • Attach the collective agreement on picketing; or
      • If no collective agreement on picketing, complete Annexure A to this form.
      • If referring a request for establishment of picketing rules, complete Annexure A to this form.
      • If referring a dispute relating to breach or interpretation of picketing rules, attach a copy of the picketing rules.


      DISPUTES RELATING TO COMPLIANCE ORDERS
      If referring a dispute relating to a compliance order, the order must be attached to this form. If the dispute is referred after the date on which compliance was due to you are required to apply for condonation.

      LEGISLATION REFERENCES
      • Labour Relations Act, 1995 Sections 9, 16, 21, 22, 24, 26, 45, 61, 63, 64, 72, 74,86, 89, 94, 134, 191(1), 198 and 198A-C.
      • Employment Equity Act, 1998 Section 10.
      • Basic Conditions of Employment Act, 1997 Sections 41, 69(5), 73A, 80, 84.
      • Skills Development Act, 1998 Section 19.
      • National Minimum Wage Act, 2018 Section 4(8).