RECORD OF SETTLEMENT
Section 149 Employment Relations Act 2000
Names of the Parties: N.B. Use the ful legal name of the entity where appropriate.
Name (“Applicant”)
Name (“Respondent”)
Agreed Terms of Settlement to Employment Relationship Problems
1. These terms of settlement and all matters discussed in mediation shal remain, so far as the law
allows, confidential to the parties.
2. Insert clauses as needed – e.g.
_________________ will pay _______________ within __ days of the date of this agreement,
compensation of $_________ under section 123(1)(c)(i) of the Employment Relations Act 2000.
This amount wil be paid to ________________ by way of direct credit to their nominated bank
account.
3. In reaching this agreement the parties confirm that they have not agreed to forgo minimum
entitlements (e.g. money or leave entitlements under the Minimum Wage Act 1983, or the Holidays
Act 2003, or the Home and Community Support (Payment for Travel Between Clients) Settlement
Act 2016 as specified in section 148A(3) of the Employment Relations Act 2000).
4. This is the ful and final settlement of al matters between _________________ and
_______________ arising out of their employment relationship.
Dated at [location] this ____ day of _______, 20__
N.B. Where signature is on behalf of a legal entity, please supply name of authorised
signatory
Signature (“Applicant”)
Signature (“Respondent”)
Name (if authorised signatory):
Name (if authorised signatory):
We confirm that we ful y understand that once the Mediator signs the agreed terms of settlement:
1. the settlement is final and binding on and enforceable by us; and
2. except for enforcement purposes, neither of us may seek to bringthose terms before the
Employment Relations Authority or Court whether by action, appeal, and application for review, or
otherwise; and
3. The terms of settlement cannot be cancelled under Section 36 to 40 of the Contract and
Commercial Law Act 2017; and
4. that section 149(4) provides that a person who breaches an agreed term of settlement to which
subsection(3) applies is liable to a penalty imposed by the Employment Relations Authority.
Dated at [location] this ____ day of _______, 20__
N.B. Where signature is on behalf of a legal entity, please supply name of authorised
signatory
Signature (“Applicant”)
Signature (“Respondent”)
Name (if authorised signatory):
Name (if authorised signatory):
F or official use only
F or official use only
I ___________________
,
Mediator,
of
[location], certify the following:
I ___________________
,
Mediator,
of
[location], certify the following:
a) I am employed or engaged by the Chief Executive of the Ministry of Business, Innovation and
Employment to provide mediation services under the Employment Relations Act 2000; and
g) I am employed or engaged by the Chief Executive of the Ministry of Business, Innovation and
b) Em
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149 of the Employment Relations Act 2000, agreed terms of settlement; and
h) I hold a current general authority from the Chief Executive to sign, for the purposes of section
c) 149
I ha o
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ections 1 48A,
149(1) & (3); and
j) before I signed the agreed terms of settlement I explained to them the effect of sections 148A,
e) 14
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h and
at
the parties have advised me that to the best of their knowledge, no minimum
entitlements (money or leave entitled under the Minimum Wage Act 1983, or the Holidays Act
k) I confirm that the parties have advised me that to the best of their knowledge, no minimum
2003, or the Home and Community Support (Payment for Travel Between Clients) Settlement
entitlements (money or leave entitled under the Minimum Wage Act 1983, or the Holidays Act
Act 2016” with “the Home and Community Support (Payment for Travel Between Clients)
2003, or the Home and Community Support (Payment for Travel Between Clients) Settlement
Settlement Act 2016, or the Care and Support Workers (Pay Equity) Settlement Act 2017” have
Act 2016” with “the Home and Community Support (Payment for Travel Between Clients)
been breached in the reaching of this settlement; and
Settlement Act 2016, or the Care and Support Workers (Pay Equity) Settlement Act 2017” have
f) been
I am br
sa ea
tis ched
fied in the
that
r
the each
parti ing
es o
u f t
nd h
eris
st se
antt
d lem
theen
e t;
ff an
ect d
o f sections 148A, 149(1) & (3), and have
affirmed their request that I should sign the agreed terms of settlement.
l) I am satisfied that the parties understand the effect of sections 148A, 149(1) & (3), and have
I sigaffi
n t rm
he ed their
attach r
ed equ
agr e
e st tha
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t I should
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49 en
(1) t.
& (3).
I sig
n the attached agreed terms of settlement pursuant to section 149(1) & (3).
Dated at
[location] this __________day of ________, 20__
D
ated at
[location] this __________day of ________, 20__
Signed
Si
gned
Mediator
Mediator