1964_EMPLOYEES__COMPENSATION_(RULES_OF_COURT)_RULES — Page 20

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CAP. 282]

Employees' Compensation (Rules of Court) Rules

[1983 Ed.

[Subsidiary]

In the matter of an Application between-

and

applicant,

respondent.

It is ordered that (1)

do forthwith pay to (2)

at (3)

heard on the

day of

the sum of $.

..........

said (1)

to the said (2)

the taxed or assessed costs of an application 19........., and being the amount now due from the

in respect of a monthly payment of

day of ......

from the

19......... being the

date of the injury, to the date of order; and do further pay at the same place on

every otherwise ordered, the sum of.

day from the date of this order until

Dated this

day of

(1) Employer's name and address.

(2) Employee's name and address.

(3) Place where payment is to be made.

The

Case No.

19......

Registrar of the Court

FORM 8

EMPLOYEES' Compensation (Rules of Court) Rules

Application for the Revision of a Periodical Payment

In the matter of an Application between-

Court of

[rule 28.]

An application is hereby made by

against

and

revision of the order made by the Court on the

between the said parties on the

19......

applicant,

respondent.

with respect to the .... day of

19........., (or the agreement arrived at

day of

) and for the termination (or suspension, diminution,

or increase, as the case may be) of the monthly payment payable to the said under the said order

(or agreement) in respect of personal injury which arose out of and in the course of his employment.

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