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[接上页] (c) overtime or other special remuneration for work done, whether in the form of bonus, allowance or otherwise, if it is of a constant nature; and (d) customary tips.But remuneration for intermittent overtime, casual payments of a non-recurrent nature, the value of travelling allowances or concession and the employer's contributions to provident funds are not included. (L.N. 469 of 1996) ______________ FORM 3 [regulation 5] EMPLOYEES' COMPENSATION ORDINANCE (Chapter 282) DETAILS OF CERTIFICATE 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 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 ....................................................................................................... ................................................................................................................................... 6. Amount of compensation determined by the Commissioner for Labour (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 as to compensation ................ ................................................................................................................................... ................................................................................................................................... 8. Any other information .................................................................................................. ................................................................................................................................... ................................................................................................................................... I, .................................... do solemnly and sincerely declare that the foregoing particulars stated are true and I make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of the Oaths and Declarations Ordinance (Cap 11). |