Industrial Relations Form I: memorandum of settlement

Record the parties, dispute and agreed terms; distinguish a conciliation settlement from an agreement reached outside conciliation.

See rule 4 · Industrial Relations (Central) Rules, 2026 · Central-sphere scope

Download and read the completed example

Download filled sample PDF

Completed fictional memorandum of settlement concerning Illustration Central Engineering Ltd (fictional), 14 Example Works, New Delhi 110001. The selected legal route and inapplicable alternatives are identified below.

Fictional, unsigned completed illustration. It demonstrates this form’s fields; it is not a filed return, medical opinion, official order or proof of an actual transaction.

When and how this form is used

Rule 4 prescribes Form I. Record the representatives’ actual authority, a short recital and precise enforceable terms, rather than a vague promise to settle later.

The form’s note directs a copy of an outside-conciliation memorandum to the concerned Deputy Chief Labour Commissioner (Central). Do not describe it as a conciliation settlement merely by inserting an officer’s name. The binding scope follows the Code and the actual settlement route.

The completed fields

Parties and recital

Prescribed field / section	Completed fictional entry
Employer representative	Kavita Shah, authorised director for Illustration Central Engineering Ltd (fictional), 14 Example Works, New Delhi 110001
Worker representative	Asha Verma, authorised officer of Illustration Engineering Workers Union (fictional); union authority assumed and not certified
Dispute recital	Twelve named workers claimed unpaid September 2026 shift allowance at ₹2,000 each; employer agrees the ₹24,000 principal is due.
Settlement route / date	Outside conciliation; 20 October 2026; conciliation-officer signature N/A

Agreed terms and execution

Prescribed field / section	Completed fictional entry
Term 1: amount / beneficiaries	₹2,000 to each of 12 affected workers listed in the real beneficiary annexure; total ₹24,000
Term 2: payment	Bank credit by 30 October 2026 to individually verified accounts; employer supplies payment reconciliation
Term 3: scope	Settlement resolves only the identified September shift-allowance demand; no blanket waiver of unrelated statutory claims
Party signatures / witnesses	Kavita Shah / Asha Verma; witnesses Neha Das and Arun Mehta (fictional); all Unsigned fictional illustration; no seal, filing acknowledgement or authority act executed
Copy / officer	Copy to concerned Deputy Chief Labour Commissioner (Central) because settlement is outside conciliation; no officer attestation asserted

Supporting records and reconciliation

Representative mandates, demand and wage/allowance basis, beneficiary schedule, signed agreement and service/copy records; later actual payment evidence.

Worked calculation: 12 workers × ₹2,000 = ₹24,000 principal.

Official source and version

Official Ministry of Labour Gazette PDF, Form I, PDF pages 73–73

Industrial Relations Code 2020, actual relevant sections; Gazette Act 35 of 2020

Act 1 of 2026, section 2 substitutes section 104 repeal/authority continuity

Download the official source pages containing this form. Adjacent prescribed forms can share a source page; use the heading and rule identified above.

These are Central Rules. Use the actual appropriate government and authority. The 2026 amending Act substitutes section 104’s repeal/continuity provisions and continues existing Tribunals/statutory authorities until the Code authorities function: https://egazette.gov.in/WriteReadData/2026/270186.pdf. Enacted Code: https://egazette.gov.in/WriteReadData/2020/222118.pdf

Practical questions

Can I submit the sample as my own completed form?

No. Replace the fictional facts with accurate records, use the competent filing or record-keeping route described above and complete genuine signatures or certifications where required.

What makes the example specific to this form?