NOTICE and ANNEX A - FINAL VERSION

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Republic of the Philippines

Department of Labor and Employment


NATIONAL LABOR RELATIONS COMMISSION

(REGION)
SINGLE-ENTRY APPROACH (SEnA) Certified No.: AJA15-0048E
(Per Department Order No. 151-16, Series of 2016)

IN THE MATTER OF THE REQUEST FOR ASSISTANCE SEAD NO. NLRC-RAB_______________


(RFA) OF:

Requesting Party/ies

Responding Party/ies

NOTICE

RESPONDING PARTY
COMPANY
ADDRESS
CONTACT NO/FAX NO/EMAIL ADDRESS

GREETINGS!

You are hereby NOTIFIED that a REQUEST FOR ASSISTANCE (RFA) under the SINGLE ENTRY
APPROACH (SEnA) has been filed involving you and your company . Attached herewith is a copy of the RFA
and of the specific demands/claims/ reliefs sought (Annex “A”) by the requesting party including the latter’s
contact number/fax number/e-mail address.

In this connection, you are hereby directed to manifest if you are open to explore the possibility of
settlement.

In case you are willing to explore settlement, you are directed to:

1. Submit your specific proposal for settlement to the undersigned SEnA CON-Med within five
(5) calendar days from receipt of this Notice, copy furnished the requesting party; Proposal may
be sent to the herein email address of the RAB ________________.
2. Communicate with the requesting party in his/her given contact address/number in the RFA to
negotiate for settlement within 15 calendar days from receipt of this Notice. Once settlement is
reached, a notarized settlement agreement with proofs of actual receipt of the agreed settlement
amount shall be submitted to the Receiving and Docket Unit of the concerned RAB. The
notarized agreement shall state the reference number docketed in the RFA and the name of the
SEnA CON-MED.

.
Should you need the assistance of the undersigned to facilitate settlement, a request in writing should
be made within 15 calendar days from receipt of this Notice, provided a specific proposal for settlement have
been submitted.

The undersigned will determine the necessity of setting the RFA for conciliation mediation conference
based on the demand of the requesting party and and your specific proposal for settlement. If the undersigned
determine that conducting the conciliation-mediation conference is not necessary , the undersigned, may motu
proprio, and without need of notice, terminate the SEnA proceedings and issue the referral for the filing of
complaint for compulsory arbitration or to the appropriate agency which has jurisdiction over the issue raised .

If the parties failed to enter into settlement agreement within 30 days from date of mailing of this Notice
or no proposal for settlement is received by the undersigned within the period stated therein, the SEnA
proceedings shall be terminated. The undersigned shall issue the referral for compulsory arbitration or to the
appropriate agency which has jurisdiction.

Information and statements given in confidence at the conciliation-mediation proceedings shall be


treated as privileged communication and shall not be used as evidence in any arbitration proceedings, except
stipulation of facts which form part of the settlement; facts which are of common knowledge; or waiver of
confidentiality. (Sec. 9, Rule IV, The Rules of Procedure of the Single Entry Approach [SEnA]).

_________2020, Quezon City, Philippines.

SEnA Conciliator-Mediator

.
Annex “A”

DEMANDS/CLAIMS/ RELIEFS SOUGHT


BY THE REQUESTING PARTY

☐ Reinstatement
☐ Regularization

PAYMENT OF
☐ Salary/Wage
☐ Salary/Wage Differential
☐ Overtime Pay
☐ Holiday Pay
☐ Holiday Pay/Premium
☐ Rest Day Premium
☐ Service Incentive Leave
☐ Service Charges
☐ Night Shift Differential
☐ Maternity Benefits
☐ Paternity Pay
☐ Vacation Pay
☐ Sick Leave Pay
☐ 13th Month Pay
☐ Separation Pay
☐ Salaries for the Unexpired Portion of the Contract (OFW)
☐ Disability/Medical Benefits
☐ Repatriation/Transportation Cost
☐ Death Benefits

☐ Other Demands/Claims/Relief Sought


(Please specify) ________________________

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