1964_EMPLOYEES__COMPENSATION_(RULES_OF_COURT)_RULES — Page 22

B 22

CAP. 282]

[Subsidiary]

1

Before

on

Employees' Compensation (Rules of Court) Rules

day, the

day of

[1983 Ed.

. 19.........

Upon revision of the order for periodical payments made on the

day of

arrived at between the said parties on the

by

for the applicant and Mr.

19...... (or the agreement day of 19......) and upon hearing the evidence given

and Mr.

...... for the respondent.

It is hereby ordered that the said order/agreement be varied in the following

manner:

and that the costs of the said

of and incidental to this application and order be taxed or assessed and paid by the said

to the said

Dated this....

day of

19......

Registrar of the Court

FORM 10

EMPLOYEES' Compensation (Rules of Court) Rules Notice by Principal Contractor to Sub-Contractor

The

Case No.

In the matter of an Application between-

To (1)

Court of

and

[rule 22.]

.., applicant,

2

respondent.

Notice is hereby given to you that an application/a claim for compensation is made against (2)

by (3)

the said (4)

who alleges that

is liable to pay him compensation in respect of an accident which occurred at (5)

on the

of

19

Dated this

day of

(6)

(1) Name and address of the sub-contractor.

(2) Name and address of principal contractor.

(3) Name and address of employee.

(4) Name of principal contractor.

(5) Place of accident.

(6) Signature and address of person giving the notice.

19......

day