【法规名称】
【法规编号】 79975 什么是编号？
【正 文】
第5页 CAP 282A EMPLOYEES' COMPENSATION REGULATIONS
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[接上页] Important Notes (1) To be completed and returned in DUPLICATE to the Commissioner for Labour- (a) WITHIN 7 DAYS of the death of the employee; or (b) WITHIN 14 DAYS of the employee's incapacity; or (c) WITHIN such period of time as required by the Commissioner for Labour. (2) An employer who fails to give notice as required or who gives any false or misleading information to the Commissioner for Labour may be prosecuted. (3) Please "P" in the appropriate box. (4) Please read the instructions carefully before completing this Form. _______________ FORM 2A EMPLOYEES' COMPENSATION ORDINANCE (CAP 282) SECTION 15 NOTICE BY EMPLOYER OF THE DEATH OR INCAPACITY OF AN EMPLOYEE DUE TO OCCUPATIONAL DISEASE To the Commissioner for Labour I declare that the information given in this form is, to the best of my knowledge, true and accurate. Signature: _____________________________________ (for and on behalf of the employer) Name (in block letters): .__________________________________ Position: □ Sole proprietor □ Partner □ Manager □ Officer Date: _____________________ _______________________________ Chop of Company (Note 1) A. Particulars of the employee Name of employee (Surname first) Identity Card/Passport No. Telephone No. Fax No. Address Date of birth _____/_____/____ Day/Month/Year Sex □Male □Female Occupation An apprentice □ Yes □ No Duration of employment From ________________ to _________________ B. Particulars of employer Name of employing company/person Business Registration Certificate No. (Note 2) Telephone No. Address Trade Fax No. C. Particulars of principal contractor/holding company (Note 3) Name of principal contractor/holding company Business Registration Certificate No. Telephone No. Address Trade Fax No. D. Particulars of the occupational disease Name of hospital or clinic where the employee received treatment Date of commencement of the occupational disease _____/_____/_____ Day/Month/Year Disease suffering from Type of work attributed to the occupational disease The disease resulted in □ temporary incapacity □ permanent incapacity □ death on ______/______/_____ Day/Month/Year E. Details of insurance (Note 4) Name and address of insurance company at the time of the employee's incapacity or death (Please refer to the insurance policy) Policy No. F. Details of earnings of the employee Average number of working days per month □ 22 □ 24 □ 26 □ 30 □ Others ________________ (please specify) Rest day is (a) □ not paid □ paid (b) □ not fixed □ fixed on _____________________ (Day of week) Details of earnings per month for the month immediately preceding the date of the employee's incapacity or death: (Note 5) (a) Basic salary/wages (b) Food allowances/value of free food provided by employer (c) Other items: ____________________________________ (please specify) Total (a) + (b) + (c) $ ______________/month $ ______________/month $ ______________/month $ ______________/month Average monthly earnings of the employee for the past 12 months (or total period of employment, if less than 12 months) preceding the employee's incapacity or death were $ ______________/month G. Fatal case (to be completed where the occupational disease results in death) Whether police was notified □ Yes _____________________ (name of police station) Name and address of next-of-kin of the deceased employee Relationship with the deceased employee □ No Telephone No. H. Direct settlement (to be completed only where the occupational disease results in temporary incapacity for not more than 7 days and no permanent incapacity, and the employer and employee have chosen to directly settle the employees' compensation claim) Period of sick leave from ______/______/____ to _______/______/____ Day/Month/Year Day/Month/Year _____/_____/____ to _____/_____/____ Day/Month/Year Day/Month/Year Total number of sick leave days: ____________ days Amount of compensation: $ __________________ □ paid □ to be paid on ______/______/_____ Day/Month/Year Explanatory Notes Note 1: The signature and company chop which appear in both copies of Form 2A submitted to the Commissioner for Labour should be in the original. Note 2: If the Business Registration Certificate No. is not available, the Identity Card No. of the employing person should be entered. Note 3: Section C on particulars of principal contractor/holding company should be completed only when the employer is either- (a) a subcontractor; or (b) a subsidiary of a holding company within the meaning of the Companies Ordinance (Cap 32) and which is covered by and specified in the insurance policy taken out by the group of companies to which it belongs.Note 4: The name and address of the insurer as appeared on the insurance policy, instead of those of the broker or agent, should be entered here. Note 5: Earnings include- (a) cash wages; (b) the value of any privilege or benefit which can be estimated in cash, e.g. food, fuel or quarters supplied to the employee if, as a result of the accident, he is deprived of any of them; |
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