1964_EMPLOYEES__COMPENSATION_REGULATIONS — Page 9

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1987 Ed.]

Employees' Compensation Regulations

[CAP. 282

A 9

[Subsidiary]

[reg. 5.]

FORM 3

EMPLOYEES' COMPENSATION ORDINANCE

(Chapter 282)

DETAILS of Certificate OR AGREEMENT AS TO THE AMOUNT OF COMPENSATION PAYABLE BY THE EMPLOYER

(This form must be completed and lodged with the Registrar of the Court by the party who desires the certificate or agreement to be made an order of the Court)

Name, address and business of employer

2. (a) Name and address of employee

(b) Occupation (1)

(d) Sex

(e) Compensation already received in respect of this accident (if any)

(a) Date of accident

(b) Cause of accident

Contract of employment (3)

Date of certificate or agreement

Amount of compensation determined by the Commissioner for Labour or

agreed upon by the employer and employee (4)

(a) Amount payable in a lump sum

(b) Amount and period of periodical payments

Date of the Commissioner for Labour's issue of certificate or approval of the

agreement as to compensation

8. Any other information

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1987 Ed.] Employees' Compensation Regulations [CAP. 282 A 9 [Subsidiary] [reg. 5.] FORM 3 EMPLOYEES' COMPENSATION ORDINANCE (Chapter 282) DETAILS of Certificate OR AGREEMENT AS TO THE AMOUNT OF COMPENSATION PAYABLE BY THE EMPLOYER (This form must be completed and lodged with the Registrar of the Court by the party who desires the certificate or agreement to be made an order of the Court) 1. Name, address and business of employer 2. (a) Name and address of employee (b) Occupation (1) (c) Age (d) Sex (e) Compensation already received in respect of this accident (if any) 3. (a) Date of accident (b) Cause of accident (c) Nature and circumstances of injury (2) 4. Contract of employment (3) 5. Date of certificate or agreement 6. Amount of compensation determined by the Commissioner for Labour or agreed upon by the employer and employee (4) (a) Amount payable in a lump sum (b) Amount and period of periodical payments (c) To whom payable 7. Date of the Commissioner for Labour's issue of certificate or approval of the agreement as to compensation 8. Any other information

Baseline (Original)

1987 Ed.] Employees' Compensation Regulations [CAP. 282 A 9 [Subsidiary] [reg. 5.] FORM 3 EMPLOYEES' COMPENSATION ORDINANCE (Chapter 282) DETAILS of Certificate OR AGREEMENT AS TO THE AMOUNT OF COMPENSATION PAYABLE BY THE EMPLOYER (This form must be completed and lodged with the Registrar of the Court by the party who desires the certificate or agreement to be made an order of the Court) 1. Name, address and business of employer 2. (a) Name and address of employee (b) Occupation (1) (c) Age (d) Sex ..... (e) Compensation already received in respect of this accident (if any) 3. (a) Date of accident (b) Cause of accident (c) Nature and circumstances of injury (2) 4. Contract of employment (3) 5. Date of certificate or agreement 6. Amount of compensation determined by the Commissioner for Labour or agreed upon by the employer and employee (4) (a) Amount payable in a lump sum (b) Amount and period of periodical payments (c) To whom payable 7. Date of the Commissioner for Labour's issue of certificate or approval of the agreement as to compensation 8. Any other information ....

2026-05-04 16:13:29 · Baseline

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