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## (U No ..............................................) \[name of member\] \[place and date\] An application for relief in respect of termination of employment has been lodged on the following ground or grounds:  the termination was harsh, unjust or unreasonable  an alleged contravention of section 170CK of the Act  an alleged contravention of section 170CL of the Act  an alleged contravention of section 170CM of the Act  an alleged contravention of section 170CN of the Act In accordance with subsection 170CF (2) of the Workplace Relations Act 1996, the Commission certifies that all reasonable attempts to settle the matter by conciliation have been, or are likely to be, unsuccessful in respect of the following ground or grounds:  the termination was harsh, unjust or unreasonable  an alleged contravention of section 170CK of the Act  an alleged contravention of section 170CL of the Act  an alleged contravention of section 170CM of the Act  an alleged contravention of section 170CN of the Act An assessment of the merits of the application has been indicated to the parties in the following terms: \[set out terms of assessment\] The Commission recommends that the applicant not pursue the application\* AND/OR Having regard to all the material before the Commission, the Commission concludes under subsection 170CF (4) that the applicant has no reasonable prospect of success at arbitration in relation to the ground that the termination was harsh, unjust or unreasonable.\]\* \* Omit if inapplicable BY THE COMMISSION: \[Signature of member\] Member’s Title > Note The applicant has 7 days from the date of this certificate within which to lodge a notice of election.