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[接上页] Dated this .................. day of ........................ 19 ........ (3) ............................................................... ............................................................... ...............................................................______________________________________________________________________ (1) Name and address of employee, applicant, or respondent to whom request is made. (2) State shortly and clearly under consecutive numbers the questions to which answers are requested. (3) Signature and address of person making the request. ___________ FORM 7 [rule 26] EMPLOYEES' COMPENSATION (RULES OF COURT) RULES Order for Periodical Payments The ................................................................. Court of ....................................................... Case No. .............................................................................................................................. In the matter of an Application between- .............................................................................................................................., applicant, and.........................................................................................................................., respondent. It is ordered that (1) ......................................................................................................... ............................................................................................................................................. do forthwith pay to (2) ............................................................................................................. at (3) .................................................................... the taxed or assessed costs of an application heard on the ................................................. day of .......................................... 19 ......., and the sum of $ ..................................................................... being the amount now due from the said (1) ................................................................................................................................... to the said (2) .......................................................................................................................... in respect of a monthly payment of ............................................................................ from the ........................... day of ............................. 19 ......... being the date of the injury, to the date of order; and do further pay at the same place on every ........................................................... day from the date of this order until otherwise ordered, the sum of ............................................ Dated this ................. day of ....................... 19 ........ ............................................................... Registrar of the Court______________________________________________________________________ (1) Employer's name and address. (2) Employee's name and address. (3) Place where payment is to be made. ______________ FORM 8 [rule 28] EMPLOYEES' COMPENSATION (RULES OF COURT) RULES Application for the Revision of a Periodical Payment The ................................................................. Court of ....................................................... Case No. .............................................................................................................................. In the matter of an Application between- .............................................................................................................................., applicant, and.........................................................................................................................., respondent. An application is hereby made by ........................................................................ against .................................................................... with respect to the revision of the order made by the Court on the .................... day of .................................................................... 19 ..........., (or the agreement arrived at between the said parties on the .................. day of ....................... 19 ....................) 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. Particulars are hereto appended (or annexed)- PARTICULARS (1) Name and address of injured employee ................................................................... .............................................................................................................................(2) Name and place of business of employer by whom compensation is payable .............. |