Formis. First
Schedula.
Returns.
Second Schedule.
T. The forms contained in the First Schedule or forms to the like effect shall be used with such variations and modifica- tions as the circumstances may require.
(1) Every employer employing persons who are work- men under the Ordinance and every insurer carrying on the business of insuring employers against their liabilities under the Ordinance shall make the return specified in the Second Schedule so far as the same is applicable.
(2) Such return shall be lodged with the Commissioner of Labour on or before the 31st of January in each year and shai! be in respect of the period 1st January to 31st December of the preceding year: Provided that no return shall be made in respect of the period 1st December to 31st December, 1953.
FORM 2.
WORKMEN'S COMPENSATION ORDINANCE. 1953.
(reg. 4.
NOTICE BY EMPLOYER OF ACCIDENT RESULTING IN PERSONAL INJURY TO A WORKMAN.
To the Commissioner of Labour, Hong Kong.
Notice is hereby given that
a workmann in my employ on the (2) AL (3)
(4)
day of....
10.
CANAAN PERATURA................................ Met with an accident causing bis **********************, and that the cause of the injury/
death was (6)
Dated this
*......orgepiny day of ................................................Py+reboten
(a)
19.........
MARKOSTOPKdEkkodbedeebok÷AGA+++++k
MAROKKOLATOKRAJINOLARAK KELANTANEONATOLONY
Council ChaMBER,
24th November, 1953-
FIRST SCHEDULE.
FORM 1.
Clerk of Councils.
[reg. 7.
[rag. 3.
WORKMEN'S COMPENSATION ORDINANCE, 1953.
NOTICE OF ACCIDENT BY OR ON BEHALF OF WORKMAN.
To (1)
(1) Full name and address of workman.
(2) Data of meeldent,
(5) Place of mecident.
40
Whether diablement or denik.
(5) Skabe in phup and ordinary tering the cause of the injury or dauth.
Signstorm and addrem of the employer.
1.
FORM 3.
freg. 5.
WORKMEN'S COMPENSATION ORDINANCE, 1963.
DETAILS OF AGREEMENT AS TO THE AMOUNT OF COMPENSATION PAYABLE BY THE EMPLOYER.
(This form must be completed and lodped with the Registrar of the Court by the party who desires the agréement to be made an order of the Court). Name, address and business of employer
DAMAN
Notice is hereby given that (2)
on the (1)
KARANGONAN MANTRA
day of
19................ at (4)
2.
(a) Name and address of workman
ANAKANJOOOOOOARTAJONOVAKOVANERAMANNAA
adda qach
......................... met with an accident causing his (6) and that the cause of the injury/death was (6)
HANNA MAN
And notice is hereby further given that in consequence thereof compensation is claimed from you.
(b) Occupation (1)
(c) Age
(8) Compensation álready received in respect of this accident (if any)
(d) Sex
Dated this harmoonian
day of
(7)
JANTANPAthletes NEAR
(1)
Nurne and address of the explorer or principal.
(2)
Fall Houde and nådreau of the workmanp.
(3) Date of accident.
TO
Flace of the mocident.
(6)
Whether diablement or death.
(c)
State in plain and ordinary berme the cause of the injury or death.
(7)
Signature and address of person giving the notion.
3.
(a) Date of secident
19.......
(b) Cause of accident
(c) Nature and circumstances of injury (2)
4.
Contract of employment (3)
5.
Date of agreement
-------DOPALING