B 12
CAP.282]
Employees' Compensation (Rules of Court) Rules
[1983 Ed.
[Subsidiary]
L.N.227/83.
(七)尙按照該條例第十條之規定而聲稱其本人業已暫時喪失工作能力,則申請人在此段暫時喪失工作能力期間,每月賺取之收入(如有)或有能力賺取之收入(如知悉)爲,
(八)聲請賠償額..
(九)將該宗意外事件通知答辯人之日期,
(十)如並未通知答辯人,講述明未予通知之理由。
申請人或其代表律師之姓名及地址-
申請人......
其代表律師.....
本申請書應予送達之(各)答辯人姓名及地址....
一九
年
月
日
請將不適用者刪去。
申請人/代表申請人之律師
FORM 2
[rule 16.]
EMPLOYEES' COMPENSATION (RULES OF COURT) RULES
The
Application on behalf of Dependants of Deceased Employee in respect of Compensation Payable where death has resulted from injury to the Employee
Case No.
In the matter of an Application between-
Court of
and
applicant,
respondent.
19......, personal injury
1. (a) On the
was caused to
day of
causing death by accident arising out of and in the course of employment by the respondent/*1st respondent.
deceased, an employee employed