Request for Arbitration

READ FIRST

WHAT IS THE PURPOSE OF THIS FORM?

If conciliation fails, a party may request that the PSCBC resolve the dispute through arbitration.

WHO FILLS IN THIS FORM?

The party requesting the arbitration.

WHERE DOES THIS FORM GO?

It is filed with the PSCBC in terms of the Dispute Resolution Rules of the Council.

 

Request for Arbitration

1. DETAILS OF PARTY REQUESTING ARBITRATION

Name(*)

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Applicant Contact Person(*)

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Applicant Telephone(*)

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Applicant Cell(*)

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Applicant Fax

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Applicant Email(*)

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2. DETAILS OF OTHER PARTY

Department Name(*)

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Department Contact Person(*)

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Department Telephone Number

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Department Cell Number

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Department Fax Number

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Department Email(*)

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3. DISPUTE DETAILS

PSCBC Case Reference Number(*)

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The case between (party)(*)

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and (other party)(*)

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was referred for conciliation but remains unresolved as of(*)

Please enter date

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Please attach the outcome certificate as proof that the conciliation was unresolved "Additional documentation, if needed" below.

Note: If 90 days has lapsed since date of Certificate, Condonation may be required.
Click here to download the Condonation Form.

 

I/we now request that the matter be resolved through arbitration.

The issue in dispute is ....(*)

0/300

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4. WHAT DECISION WOULD YOU LIKE THE ARBITRATOR TO MAKE?

 

0/300

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5. ANY SPECIAL FEATURES/ADDITIONAL INFORMATION

Do you require an Interpreter?

NoYes Invalid Input

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6. POPIA CONSENT

By completing and submitting this referral form with the PSCBC, you therefore agree, that the PSCBC may process personal information on the terms and conditions set forth in the PSCBC's privacy policy, available at:
https://pscbc.co.za/pscbc-privacy-policy-manual

Do you understand the above?(*)

Yes Invalid Input

Please upload and additional documentation, if necessary

Add another file Invalid Input

7. CONFIRMATION OF ABOVE DETAILS

By submitting this form via the PSCBC e-Referral platform, service is presumed unless the contrary is proven.

I/we further confirm that I/we have the necessary authority to sign this form.

 

Form submitted by (name)(*)

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Capacity in which the form is signed:(*)

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Signed at(*)

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Date(*)

Please enter date

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This form is presumed as electronically signed in terms of the relevant provisions of the Electronic Communications and Transactions Act 25 of 2002.

I hereby confirm that the information above is correct

Yes I confirm Invalid Input

Submit

Copies of this form will be sent to:
PSCBC
DPSA
Respondent
Applicant

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