1964_LABOUR_TRIBUNAL_(FORMS)_RULES — Page 12

C 12

CAP.25 |

Labour Tribunal (Forms) Rules

[Subsidiary]

[1984 Ed.

FORM 10

表格第十款

Labour TRIBUNAL ORDINANCE

(Chapter 25)

勞資審裁處條例 (香港法例第二五章)

CERTIFICATE OF SETTLEMENT

協議證明書

{title as in Form []

[s. 15(7).]

(條例第十五條第(七)款)

We, (a)

(標題部份如表格第一款所示)

余等 (甲)

parties to this claim, hereby agree to a settlement of this claim on the following

乃此宗聲請案之當事人，茲按照下開條件達成協議:

terms:

(b)

(2)

The above agreement has been interpreted to us in the

上述協議之內容已由傳譯者用

dialect and understood by us.

語向余等傳譯，余等已完全明白其一切內容。

Dated this ... day of ... 19.........

日期: ... 年

#

H

Before me.

此項協議乃在本人面前簽証,

Authorized Officer.

(丙)

(C)

(Signature of Claimant(s)).

(聲請人簽署)

(Signature of Defendant(s)).

(答辯人簽署)

受權人員

Filed this ... day of ...

存案日期: ... 年 ... 月 ... 日

19.....

Registrar.

經歷司

L.S.

(加蓋封印處)

Note:

註:

(甲)

(b)

Insert full names of those parties who agree to the settlement. 填寫達成協議之各當事人全名

Set out in full the conditions on which the settlement is agreed.

(乙)

詳列達成協議之條件

(C)

寇

This certificate must be signed by all parties who agree to the settlement.

(丙) 本證明書必須由達成協議之各當事人簽署。