Why the certificate is issued
The certificate records a mediation request or court-referred mediation under the Employment Claims Act. It may be issued after a respondent fails to attend despite reasonable notice, mediation ends without settlement, or an approved mediator finds no reasonable prospect of settlement. It records the route forward, not a finding that the claim is proven.
Read the annex item by item
The annex lists contractual/statutory disputes with accrual dates, duration and amounts. Wrongful-dismissal entries separately record the remedy sought, such as compensation or reinstatement with lost wages. The certificate identifies unresolved items and any other disputes already settled, so those categories should not be combined into one undifferentiated total.
Documents for the next step
Keep the signed certificate, annex, relevant settlement agreement and the evidence supporting each unresolved item together. Check the issue date and the tribunal filing requirements promptly. The sample is explanatory; a claimant cannot issue their own referral certificate by filling in the downloaded form.