Section 135

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An employer, employee, union,
or employers’ organisation may
fill in this form. It should then go to the CCMA office in your province.

Labour Relations Act, 1995
This form assists a person or organisation to refer a dispute to the CCMA for conciliation. The CCMA will appoint a commissioner who must attempt to resolve the dispute through conciliation within 30 days. You can download the form off the CCMA website: www.ccma.org.za (click on Referral forms)

Note: If you are covered by a bargaining council, a statutory council or an accredited agency you may have to take the dispute to that council or agency. Some councils and agencies are required by law to deal with certain disputes and parties must then refer disputes there, rather than to the CCMA. You may also need to deal with the dispute in terms of a private procedure if one applies.

Provincial Offices of the CCMA:

CCMA Eastern Cape – Port Elizabeth
Registrar • Private Bag X22500 • Port Elizabeth 6000
Tel: (041) 505-4300 Fax: (041) 586-4585

CCMA Eastern Cape – East London
Registrar • Private Bag X9068 • East London 5200
Tel: (043) 743-0826 Fax: (043) 743-0810

CCMA Free State
Registrar • Private Bag X20705 • Bloemfontein 9300
Tel: (051) 505-4400 Fax: (051) 448-4468/9

CCMA Gauteng – Johannesburg
Registrar • Private Bag X096 • Marshalltown 2107
Tel: (011) 688-2200 Fax: (011) 688-2201/2/3

CCMA Gauteng – Pretoria
Registrar • Private Bag X176 • Pretoria 0001
Tel: (012) 392-9700 Fax: (012) 392-9701/2

CCMA KwaZulu-Natal – Durban
Registrar • Private Bag X54363 • Durban 4000
Tel: (031) 362-2300 Fax: (031) 368-7387

CCMA KwaZulu-Natal – Pietermaritzburg
Registrar • PO Box 72 • Pietermaritzburg 3200
Tel: (033) 345-9249 Fax: (033) 345-9790

CCMA KwaZulu-Natal – Richards Bay
Registrar • Private Bag 1026 • Richards Bay 3900
Tel: (035) 789-0357 Fax: (035) 789-1748

CCMA Mpumalanga
Registrar • Private Bag X7290 • Witbank 1035
Tel: (013) 656-2800 Fax: (013) 656-2885

CCMA North West
Registrar • Private Bag X5004 • Klerksdorp 2571
Tel: (018) 464-0700 Fax: (018) 462-4126

CCMA Northern Cape
Registrar • Private Bag X6100 • Kimberley 8300
Tel: (053) 831-6780 Fax: (053) 831-5948

CCMA Limpopo
Registrar • Private Bag X9512 • Polokwane 0700
Tel: (015) 297-5010 Fax: (015) 297-1649

CCMA Western Cape
Registrar • Private Bag X9167 • Cape Town 8000
Tel: (021) 460-0111 Fax: (021) 465-7193

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If a union or employers’ organisation is helping you with the dispute, give their details too.

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If more than one party is referring the dispute, write their details on a separate page and staple it to this form.

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If more than one other party is referring the dispute, write their details on a separate page and staple it to this form.

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Describe the issues involved. The list at the end of the form should help you. Your description will assist the CCMA in dealing with the matter. It is not meant to bind you.

CCMA Ref No:
. . . . . . . . . . . . . . . . . . . . . . . . . .

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Look at the list of disputes and their corresponding sections at the end of the form. If you are unsure which is the appropriate section, you may leave 3b blank.

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Special features might be the urgency of a matter, the large number of people involved, important legal or labour issues, etc.

Give a description of the industry, service or public sector concerned (eg. the metal industry, tourist services, provincial hospital services, etc). This will help the CCMA choose a Commissioner with experience in the particular sector or area.
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Where did the dispute arise? Usually this will be the address of the workplace

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Describe the outcome or result you would like from this conciliation. You are not bound by the proposals you make here.

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Proof that a copy of this form has been sent could be:
• a copy of a registered slip from
the Post Office
• a copy of a signed receipt if
hand-delivered
• a signed statement confirming service by the person delivering the form
• a copy of a fax confirmation slip

1. Details of Party Referring the Dispute
   Tick the box ❏
   As the referring party are you:
   ❏ an employee ❏ a union official or representative
   ❏ an employer ❏ an employers’ organisation’s official or representative
   
   If you are an employee fill in (a) below and if you are a union official or representative, an employer or an employers’ organisation’s official or representative fill in (b)
   
   a) If the referring party is an employee
   Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Tel: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fax: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Alternative contact details of employee (for example, a relative or a friend):
   Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Tel: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fax: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   
   b) If the referring party is an employer, an employers’ organisation or union
   Your contact details:
   Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Tel: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fax: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Contact person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   
2. Details of Other Party (the Opposite Party)
   Tick the box ❏
   The other party is:
   ❏ an employee ❏ a union official or representative
   ❏ an employer ❏ an employers’ organisation’s official or representative
   
   Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Tel: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fax: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Name of person dealing with the matter and other party’s reference number (if known):
   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   
3. Nature of the Dispute
   a) The dispute is about:
   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   b) The dispute relates to section . . . . . . . . . . . . . . . . . . . . . . of the Labour Relations Act, 1995.
   
4. Special Features (If Any)
   I/we would like to bring the following special features of this dispute to the attention of the Commission:
   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Delete the box below if inapplicable:
   
   Dispute about unilateral change to terms and conditions of employment [s 64 (4)]
   I/we require that the employer party not implement unilaterally the proposed changes that led to this dispute for 30 days, or that it restore the terms and conditions of employment that applied before the change.
   Signed: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (party referring the dispute)
   
5. Date of Dispute
   The dispute arose on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Give the date, or approximate date

6. Sector and Area
   The dispute exists in the following sector:
   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   and in the following area:
   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. Results of Conciliation
   The outcome I/we would like:
   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Informing the Other Party
   A copy of this form has been sent to the other party to the dispute.
   Proof of this is attached to this form.
   Signed at . . . . . . . . . . . . . . . . . . . . . . . . . . . . on . . . . . . . . . . . . . . . . . . . . . . . . . . .
   
   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   Party referring the dispute

Conciliation Referrals Section List

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For example, the contact details
of a union or an employers’ organisation which is helping or representing you. Please indicate which number in this form your comments refer to.

Additional Information
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