Republic
of the Philippines
Department
of Labor and Employment
NATIONAL
CONCILIATION AND MEDIATION BOARD
Regional
Branch No. ________
Date:_______________
The named parties, after having exhausted all the possibilities to an amicable settlement, do hereby agree:
To submit the following specific issue/s and remedy/ies sought, to arbitration:
To accept the designation and appointment of _______________________ as the arbitrator or the following as panel of arbitrators in this case.
To abide by and perform any Award hereunder and any judgment that may be rendered upon Award.
Employer: __________________________________________________________
Address: ___________________________________________________________
Telephone: _________________________________________________________
Signed by: _______________________ Position:__________________________
Union: ___________________________________________________________
Address: ______________________________________________________
Signed by: _____________________ Position:_______________________
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Name: __________________________________________________________
Office: __________________________________________________________
Address: ________________________________________________________
Telephone: _____________________________________________________
Position: ______________________________________________________
Signature: ____________________________________________________
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(For reporting and monitoring purpose, please send to the concerned Regional branch of the Board.)
FLAVAS FORM NO. 2
NCMB-NCR-FLAVAS
REFERRAL SLIP
Date:_______
Time: ______
Case: _____________________-
___________________
To: _______________________
__________________________
___ Please handle this case
___ Please call parties for conference
___ Please give preferential attention
___ Let us discuss this
Others:____________________
Chairman