1983 Ed.]
Employees' Compensation (Rules of Court) Rules
[CAP. 282
B 13
[Subsidiary]
(b) *At all material times the 1st respondent was a sub-contractor within the meaning of the Ordinance to a principal contractor within the meaning of the Ordinance namely the 2nd respondent.
2.
An application under the Ordinance is hereby made by acting on behalf of the dependants of the deceased employee against the respondent(s) for compensation pursuant to the Ordinance.
3.
Particulars are as follows-
PARTICULARS
(1) Date of birth or age of the deceased employee at the date of the accident
(2) Nature of employment of the deceased at the time of the accident
(3) Date and place of accident, nature of work on which the deceased was then engaged, and nature of accident and cause of injury
(4) Nature of injury to the deceased and date of death
(5) Monthly earnings of the deceased from employment with the respondent-
(a) for the month immediately preceding the accident
(b) on average during the 12 months (or any lesser period of employment with the employer) prior to the accident
(6) Particulars as to dependants of the deceased by whom or on whose behalf the application is made-
Name
Description
Address
Occupation
Relationship to the deceased
Wholly!
Partially
Age
Dependent
(7) Amount claimed as compensation
(8) Date of giving notice of accident to respondent(s)
(9) If notice not given, reason for omission to give such notice
The name and address of the applicant or his solicitor are-
are
Of the applicant
Of his solicitor
The name and address of the respondent(s) to be served with this application
Dated this
day of
19
* Delete as required.
Applicant/Solicitor for the Applicant