THE WORKMEN'S COMPENSATION

RULES, 19241
In exercise of the powers conferred by section 32 of the Workmen's Compensation
Act, 1923 (8 of 1923), the Governor-General in Council is pleased to make the following
rules:-
PRELIMINARY
1. Short title.-These rules may be called the Workmen's Compensation
Rules, 1924.
2. Definitions.-In these rules unless there is anything repugnant in the
subject or context,-
(a) the 'Act' means the Workmen's Compensation Act, 1923;
(b) 'Form' means a form appended to these rules;
(c) 'section' means a section of the Act.
PART I
REVIEW OF HALF-MONTHLY PAYMENTS AND
COMMUTATION THEREOF
3. When application may . be made without medical certificate.-
Application for review of a half-monthly payment under section 6 may be made
without being accompanied by a medical certificate.-
(a) by the employer on the grotmd that since the right to compensation
was determined the workmen's wages have increased;
(b) by the workman, on the ground that since the right to compensation
was determined his wages have diminished;
(c) by the workman, on the ground that the employer, having
commenced to pay compensation, has ceased to pay the same,
notwithstanding the fact that there has been no change in the
workmen's condition such as to warrant such cessation; ''
(d) either by the employer or by the workman, on the ground that the
determination of the rate of compensation for the time being in force
was obtained by fraud or undue influence. or other improper means;
(e) either by the employer or by the workman on the ground that in the
determination of compensation there is a mistake or error apparent
on the face of the record.
4. Procedure on application for review.-If, on examining an application for
reyiew by an employer in which the reduction or discontinuance of half-monthly
payments is sought it appears to the Commissioner that there is reasonable
ground for believing that the employer has a right to such reduction or
discontinuance, he may at any time issue an order withholding the half-monthly
payments in whole or in part pending his decision on the application. of::
1. Vide Government of India, Department of Industries and Labour, Notification No. L·1182,
dated 26th Jtme, 1924.

62
 . I:II~ I'

I'
•' ,i

Rule' iS]
' ,, riTI!J'lJ Wotkri7&11's Oompen,satlon Rules,. 1924 63

.,,,., ., $• Procedure rm( applicatio:ri ·for ~ommutatiort,CL.(l) Whe:te application is

ri}ade . to the Commissioner ·under section 7 for ·the 'redethpticirt :of a right to
~t.e~ebce , h<;llf·ti:iPP-tNY" tf!ay'n'te!its . by Jhe payntent rof <ii · lump sum, the
Gpp:1lf!.isSiQnet:·Shi:tll ,fqtm;,ah,,estimate of the .probable duration of the
·.@.~sP;l;Jle.~errt/'i'it].cL $h~ll ,a;ward a ,sum: 'equivalent to the totaLof .the half-monthly
,paym,ents liY'biiih •W,qWli be payable for the period during which he estimates that
.JM •diJlalJleroent ,wUlc~p,tinue, less .one~half per cent of, that total for. each month
co!rtpBsed i:tfthatper1cid: , · , .. .
.1'"' .(RJ;Pvid€g'l,.that ftq,<;tio;hs.pfa rupee included il,11:hE\ st:uh,so.computed snail be
:·~~i~t~g~:r-aeq_\r _· ·: ···!~:_;~·_/.;f/': d·.-':: ::·->:~. ;:<I_
c·;-:!_.. _·:~:. _ . ~- 1'··-.:~.~--~· ,._ ..... /" _.- ,.:' _:. .,". ·- _:· :; ~; ;:~ ·."::~_,.~::-_..·;
,.,> ·. _ .--,.. :
\;,~'(2) Whehi:in' any' ct'l:se to which sub~rule (l}applies, 1t:he Corfunission:\!r is
'unal5le.to form can appro.,qn\ate·estimate of:tlie probable duration .()f.the
disablement, he .maff:tom urtie to tiffie;postp6ne a decision on the application
fqt a ,period not exeew:li;hg two m.ortths,at ariy'one lime,.... .'
.-·~::.vtf·:--.~r· '_;_. , . _;_<,.:·:~- . '· · ·· ~r
PART
;);. .
II '{,' )_") "-

·;; .· , , gE,POSIT OF CO,MP,ENSA1,'ION r , .'

·~;,,,,,:,~1 ,~l)eposit u,:p.(i~r·s~cHOp, 8 ,(1),"",(l~,,~n·en;tploy,er. depg~iting.•,cqmpens!ltion
.:wtt,h the CoiX\ll}is~iO,ngr w:td,et1 sub-segtiqn (1); 9L~ectiQ;n.8 1 ..in respect,,o£ a
'Wqtkinari whose injury has resulted in death shallfurnish therewith a statement
in Foftl1 A, and ~hall be given a 'receiptin Form B. In other cases of deposits with
th'eCpm.missioner under sub-sectiori (i'j'@f'section8, the employer shall furnish
. a statement irt Form AA1 ,and sliall be given ,a receipt in. Form B.
.(2) 1£, When depositing compensation in respect .of. fataL accidents, the
employer indicates in the statement referred to in sl)b-rule (1) that. he desires to
be made a party to the distribution proceedings, the Commissioner shall before
1\llotti):tg the sum deposited a.s co111pensation, afford to the, employer . an
pppo,rtgnity of estab,Jt,s]yng .that the.pers9,r1 to. who!!) he proposes, to allot svch
-~UWJ~,not a;cJ.epen,dal).tqf the p_eceaS~PcrWotkl11ail.O,r 1 •.1'\S ,the.,case may be, %at
,!10,91}.~ ()~ 1~V.C.h,Pe~sqns is a cl~JPtll;ldcw,t:v ·... · .. , ,. ,
;; ,(;3,) ;rhe statement. of ,disbutseinertistq be ,fu:tni~lied ori fl.Pplication by•dhe
'' ~~Ployer tiJj.der $ubcsedion (4) of, section 8, slialLb~ .irt Fdrmi.Cr. · ',
',J,,y'10i!.t~ublicatitl11 M 1iist of· :depos~ts,'··· · :me Gormhlssioner. shllll· .cause'·'t6· be
di~):il<l;Jed, iin
a prdn'lment .· positidn'•t~U:fside his office;· ari .· ac~l!rale''li~f tiff the
. •.4.~l'~~it$ .J~~eiVtlii ~y hitn cm1de:~; •· sub"sectioh ·(1) of•?,ectiot1. 8,· togethe~• Witk the
n~:ffi~s;;.~pd,ad<:lresse~ .Of, the depositors •and ofthe vyorkman in respect ofwhps~
deatlf pr injury the deposits have beeu. :ll}a,de. . .·
·... K . Application by . ~epE;nd'!P,l~ if~.f 'dep!?~it . (If comperisation.-(1) A
dep~!i4ant,of.fi. deceased W'o¥l<:rtt~i{hlay''!j:>ply tti 'theCornmis~iom~r for tlie .Issue
Jl)f tf!h
order tb dep()$it tiontp~nsati()h iri tespect of tlie El~ath of tne w'orldrian,
$v~Ni'trP!i¢atiilP.'sl]ra,ll.be tn!l.de in F6rm c: • . ·. , ,.:...· ' , ',, •. <
' ,. --,_" - ,._ '-~'-
,,. ,·· ---:' - '-- - -· -. <, ,,~, ' ·" -'
,. " < :, ; ',' ' '" -- ' '' - ' .- '- - 7' ' ' ' '', -. . ,' '' -- ' .,'' --- _: ' - ,_ : ' ,_. _, '

.• 1 • (2);tftompenst1tiordihs ri6f beejl~<;l~}losited the ttJntriiissioiler sliaJl qis}jose

of s1J2h. appli~a,tfi:\n ili' aecof,dall.Fe)l:itli Ine' proVisions· b¥]:'art. V' df thi\!le tti1es:
~:.r_ _·:~,:f.---~~Q~~~.~~~,~~~f~~--.;t:t;·!;.~---:·.;_~\} !~_.:· : __:,·_._;f.i / ':t:'. \·:.~ ":; _ -L,. _::\,~~--~:-:rY: _)>·: ._-.-~:__\/,:'::, -?? ') ~.
,_('. . .•·. - -_,. i· f·_- ,,., -::- •·.-.. . :-:-./:~n; .<·_:·_-:' ·,, ,. _ :;~~~'{ "'--· -~1,- .
. ·.' '· · :.·•· •·· (aJ.We, eo~s~~.ori~f 'fl?,ayi ·~r· ~fl.Y;',t)r~w·r~fol:{i~~i.\e~ Ar~. tt<i~~(l;,£1 ~}11~ 1

·.1 . •·: ~ . ' •.•.. 'n. . ?. ~.·. ~-:. . ·t8·:·o

•.~. \'! .·.gi·v·· e.:nA1 ~~~.o.~.••.:/-U
. . .:.ilw..e.·r'~.s.•..:.ttl'l . t!W~.W#t.: ·. t. .o. lrl11 c?t,~h·:.•·•.~.:. . .'g'f··· tJie.. .
' ' ' ':• · • . Mpendants bf the Ct.eceasea Workfui!rt' who' ha%' nofjoirte~ ·~, $~
·\· ·,''V~·-'\,c,/•''
64 The Workmen's Compensl!!ion "Rules, 1924 [Rule 8

application, requiring them, if they desire to join therein, to appear ' .

'

before him on a date specified in this behalf;

(b) any dependantto Whoin such notice has been given and·who fails
to appear and to join in the application on the date specified in the
notice shall. not be permitted thereafter to claim that the employer is
liable to deposit compensation unless he satisfies the Commissioner
that he was prevented by any sufficient cause from appearing when
the case was called on for hearing.
(3) If, after completing the enquiry into the application, the Commissioner
issues an order requiring the employer to deposit compensation in accordance
with sub-section (1) of section 8, nothing in sub-rule (2) shall be deemed to
prohibit the allotment of any part of the sum deposited as compensation to a
dependant of the deceased workman who failed to join the application.
9. Deposit under section 8(2).-An employer depositing compensation in
accordance with sub~section (2) of section 8, shall furnish therewith a statement
in Form D 1 and shall be given a receipt in Form E.
10. Investment of money.-Money in the hands of Commissioner may be
invested for the benefit of the dependants of deceased workman in Government
Securities or Post Office Cash Certificates, or may be deposited in a Post Office
Savings Bank.
PART III
REPORTS OF ACCIDENTS
11. Reports of fatal accidents.-The report required by section lOB shall,
subject to such rules, if any, as may be made by the State Government, be in
Form EE.
12. Right of employer to present memorandum when information
received.-(1) Any employer 'lnho has received information of an accident may
at any time notwithstanding the fact that no claim for compensation has been
instituted in respect of such accident, present to the Commissioner ·a
memorandum supported by an affidavit made by himself or by any person
subordinate to him having knowledge of the facts stated in the memorandum,
embodying the results of any investigation or inquiry which has been made into
the circumstances or cause of the accident.
(2) A memorandum presented under sub-rule (1) shall, subject to the
payment of such fee as may be prescribed, be recorded by the Commissioner.
PART IV
MEDICAL EXAMINATION
. 13. Workman not to be required to submit to medical examination save in
accordance with rules.-A workman who is required by sub-section (1) of
section 11 to submit himself for medical examination shall be bound to do so in
accordance with the rules contained in this Part and not otherwise.
14. Examination .when workman and medical practitioner both on
premises.-When such workman is present at the employer's premises, and the
offers to have him examined .free of charge by a qualified medical
pr:actiti<mE~r who is so present the workman shall submi+ himself for examination
Rule 20] The Workmen's Co17JPensqtion Rules, 1924 65
t·

15. Examination in other cases.-In cases to which rule 14 does 11,ot apply,
the 'employer may- .. .. . .· , . · .. 1, . •. · .
· (a) send the medical praditiqner to the place where the 'Workman is
residing for the time. being, in which case the worl<Jnan shall submit
him~elf for ril~fic~l exan:iinat~?n on being request~d to do so by .the
rned1cal practitioner, or · ·. · · · · · ·· · . · :
· (b) send to the workman an offer in writing to have him examined free
of charge by a qualified .. medical practitioner, in: which case •the
workman shall submit ):Umself:. for medical examination at the
~nlplqyer~s premises or at such, .other place in. the vicinity as is
.. :,specified in sudt offer qnd at such time as is•so specified:
Provided that-
.(i) tl).e.,time S() 'specified .shall not, save with the express.co.nsent of the
worlGn<!!J. be beh\;een t11e h,ours of 7 p.m. an,d 6 a.m. and
(ii) irt cases were the workman's condition renders it impossible or
inadvisablE! that.he shot).ld lE!ave the. place where h,e is residing for
Hhe tim~. bei!1g~.·Ke shqll nqt .be .. *equired to . . submit himself for
. •• , ... m~3fSf-J,~xatnirl~ti~psave ~ts~chpla:ce .. · ... > , .. , . · :
.,, lp.
·-~'
- ..
Restriction
_,_~·.~
_.1_--.lr._•. , ..
,on,nu.111ber'•' of,.,~xamma,hons.-
~-'''·-'----·~--·_·.·. ,•'.. -.,·... '
... A wor!<J:nan
, __ -, , .. - ,_,• ___ _, • . ,
wh,o
',
IS mrece1pt
- ., >

ot a half-morillily paJ!nent shall 11.9t, be, requireq, to submit .himselffor medical

e~C!n,Unati<:JD .else:"\'here than . fit ,the· pl~~e 'Where he is. residing .f()r ~he tii;ne .being
more 'tha:ri fwk~' in 'the first rn'onth following the. accident or 'more than. once in
drif'srtb$e tienf''lrtonth. "' ' ' · ·. · .· ' ·.. · . · ' - ' . ' ,,. .
Ex2'mh-i~Hrin
. 'I .• 17. after, s~spel.i~idn of right to ..compensation.-··.If a wo;rkmq.n
whose tight to compensation has been suspended under sub-se<;tion (2) orsub-
section(3) of section 11 subsequently offers himself for medical examination( his
examirtation: shall take plilce on the ~rnploy~t's p~emises or at such other place
in ·the Vicini,ty as miiy befixe4 by!he ~rl1ployer, and, at a tvne to be fixed by the
employer iu:lt beii:\.gsave wiiliflte 'Eixpress cdnsenf of the ~orktr\.art, 'more. thalt 72
hours after the workman has so offered himself. 1 '

•;; . 18, Examination· of<,women.-(1) Nb iom.an• shall without her Mrtsent be

m~dically~.exa~ed!by a·male practition:ei;nsave in !the presence of AnothE!r
woriuin~,. :r\3 - --. \·ir: Cr'.. r;u,_:- ''T'-)_\

•··.· .•{'1) No ;w6m.an'•shiill be reqUired •to be illedkally ·~xiliniried 'by a .!J1~hf

practitioner if she deposits a•Sum·sufficientto cQ_vet the expenses Of exarnirlatioil:
by.a,;female practitionef'•l· · · P '"·' ''·

r'Al~~jv!'
;-,- ..,,
'l'n.<:idot.JirE" ,,,
:.::~ ( ;f~ ·.- , -: ·.; : '-.
, .
_.' .· '· )_• 1. ,. >
. " . ·'·'
< .' _: _,--; -,- - , . -
i',,'.
. . pi:ovidecl. in thes~ r)J.les, the procecl.ure
~0n:1ITlission!.e.r .. • the' dispo~al ofcasl:!~ und11r )he Act, or
n~il'ti.P< h1 SUch cases shallbe regulated in a:ccordancewith
,. . " ," '> . ·' .·. ·. . . r ' . .
• ''Jilllicati6fi.-'---(t'fJIU\v il.t)J)tlcati6n. •of·, the
~~ ····· nature
' ,,,., referred·t~
· · · ···'''···il}·· ,$ection
: ·• · 22
.·.
""'"d·"~''" post 9r may be presented to him
•.. ·... c •...• by Hibi in;tHi~behay,'ifud; if.~6sentor.
1
...

the •Co:triinissforier 'dtherwise directs1 'be made in

alJpfciJ):d.ate Forni, if any,· aild shall be signed by tlie
66 The Workmen's Compensation Rules, 1924 [Rule 20 Ru

(2) There shall be appended to every such application a certificate, which cal
shall be signed by the applicant, to the effect that the statement of facts contained Co
in the application is to the best of his knowledge and belief accurate. dis
21. Production of documents.-(1) When the application for relief is based
upon a document, the document shall be appended to the application. ap]
ap]
(2) Any other document which any party desires to tender in evidence shall ap]
be produced at or before the first hearing. ap]
(3) Any document which is not produced at or within the time specified in evi
sub-rule (1) or (2), as the case may be, shall not, without the sanction of the
Commissioner, be admissible in evidence on behalf of the party who should rna
have produced it. or
(4) Nothing in this rule applies to any document which is produced for the de;
purpose of cross-examining a witness or is handed to a witness to refresh his sh<
memory.
22. Application presented to wrong Commissioner.-(1) If it appears to the no
Commissioner on receiving application that it should be presented to another cla
Commissioner he shall return it to the applicant after endorsing upon it the date
of the presentation and return, the reason for returning it and designation of the res
Commissioner to whom it should be presented. wr
(2) If it appears to the Commissioner at any subsequent stage that an thE
application should have been presented to another Commissioner, he shall send of
the application to the Commissioner empowered to deal with it and shall inform
the applicant (and the opposite party, if he has received a copy of the application th(
under rule 26), accordingly. COl

(3) The Commissioner to whom an application is transferred under sub-rule

(2) may continue the proceedings as if the previous proceedings or any part of Wl
them had been taken before him, if he is satisfied that the interests of the parties is'
will not thereby be prejudiced. try
23. Examination of applicant.-. (1) On receiving application of the nature
set
referred to in section 22, the Commissioner may examine the applicant on oath,
or may send the application to any officer authorised by the State Government of
in this behalf and direct such officer to examine the applicant and his witnesses
and forward the record thereof to the Commissioner. it•
(2) The substance of any examination made under sub-rule (1), shall be_ rec
recorded in the manner provided for the recording of evidence in section 25.
COl
24. Summary dismissal of application.-(1) The Commissioner may, after
for
considering the application and the result of any examination of the applicant
. undter rule 23, summarily dismiss the application, if, for reasons to be recorded,
he is of opinion that there are no sufficient grounds for proceeding thereon. pr'
to
(2) The dismissal of the application under sub-rule (1) shall not of itself ari
preclude the applicant from presenting a fresh application. for the settlement of
the same matter.
thE
25. Preliminary inquiry into application.-!£ the application is not
pa
dismissed under rule 24, the Commissioner may for re<fsons to be recorded, call ap
upon the applicant to produce evidence in support of the application before ne<
 Rule s3j 67'

calling upbn any other party, <lfid; if' upcn\' cbrtsiderirtg such e-vid~nce .th~
C~iru:rtissiort~r isof opfuion tltat tl:ter~ is no ca:s'/;' f!;ir thf! reliefdairlied, he may'
di~lnj,ss the applicil'tipi:lwith 1 ilbr~¢~ !ihiteffi,ent of h}s reasons f'6r'so,doing. . ..
..... , . Notic~
, .·26.' .. •...P~.. rtY,,
. •6YP,Mite
to'
r·· . •: :~1£
. . the. .....'c61lunissidner · .. ··· .....di~:tiliss'.
, ...... :v.·· daeknot , ... the ,,
apBlication unaer 'rule 24,o~.,rtihL2?,, ~¢ ~ha.~ :s~rid .to tr,i~. p~rt;y fr6Il1':WKom the.
appvcant claims relief (hereiJ;taftet :t¢fetr¢c:i to asfhe oppoS,ite party) a cqpy of the
app'l!~~fion,together with a'ildtice of 'ffie' d1He ·o:rt 'which 'he will dispdse of .the
appli<f~tto:n,·. ~i:ltt friify ~au'·itp'()fi"i'fF!e""' arties . .to· pi"rsauce ''ITfoW lRa:r·aaFtFail ·
evillt!W¢e''whic~N1ie;Y ftlalWish.to' 1terider. i I I •• . 'i o!l.'. ,, ·;'r' I I.. •X
·'''''17.':1\ . '~at'iffi.~e ~ri'if~*aiiiiri~Htiri bfc'l ··. tisi'te. a:r'f¥;'-.(i) Tiie'o JW{ atty'
~a:Yrtiril~so reguil:~cf bt iii.¢ ~6illiili~si6~~f: ·~ilaR at sr 'bet&~ irltsrl:l~~rfug
or ·~itifut sl;.tc]J time ~s tnil' C2gi'riihisMprter' .rna:y 'peFn\it,' file a·~~itt~rt~taternent
d~alifig with the dalill; rais~a m tl:l.e'app1ital:ion, ari'd any such wfii:tetl. statement
sHall forih·part t,ft1te'record:' · < '" ..:'·' ,.. '' '··'' '> ,:, · . ·:· ., ... ',.
. (2)Hthe b~pbstf~ p~tij conl:eJts the d~inl, the CoWfus§fc!rteJ; tiJ.ay, apd, if
no ~tlttefl'$tat(?nl!)itt has bee'n ·filed, shall p~bceed lo examirfe hiM updrt the
da'irrfand shal1 i~'djlce·fhe tesulfof exa'Jllin.atlont6 'IWHtini( ·:. ··.' )'" · · · .·~
. . >!1' 2$'.,:Fi~mih' 'of'Ts~\l~~:sw 'A£fe¥~bi\Piciefi.rl' itt wditefl.'~ta.telri~iW '~rrd 'ffi~
i~suft' cii'~fi ,. e~ahlin~ti6b.'1lftth~'' '~rtres'ff{b c8~iorie~ §Ha'fi a'~itel't~~ i:f c\A
1
· wh::stt fit~.1:eil~i':r~:op6sifiiiil~;& 't~ci6t:H£1~~ tiie ~~~rl:i'&~ kre <tt\i~tlirfi.e:¢ ~d sk~il ;
tl'tel.'~tip~i'ft:'PK'hea t6 fraii:le'ar'i'Cl record thlissues'upoh whlcn tJ:l~ 'tignt''de~iSion I
. of'tHe case <ippei\.'ts tO'l:ti:trtJH'.~epenq\' , ' · ···::'>, · '. '' . :' ,~,,,, :, . " !
·· (2) 1n f~cori:iirtg the.1ssueil, 'the 'tociihls§i6ite~shaiT lilstiligJi§h)et\Ve~n
i
I

those issues which· in his opinion concern points of facts and those ·which !I' ·\
concern points' of law. · · · :·
!
'.~
'·
'

i
I
'
I

1\

I i
I,'

\-·-,--
 68 The Workmen's Compensabon Rules, 1924 [Rule 34
F
34. Exemption from payment of costs.-If the Commissioner is satisfied that
the applicant is unable, by reason of poverty, to pay the prescribed fees,_ he may
t
remit any or all of such fees. If the case is decided in favour of the applicant, the
prescribed fees which, had they not been remitted, would have been' due to be
paid, may be added to the costs of the case and recovered in such mapner as the (
Commissioner in his order regarding costs may direct. ,: r
35. Right of entry for local inspection.-A Commissioner before' whom any a
proceeding relating to an injury by accident is pending may at any time enter the
place where the workman was injured, or where the workman ordinarily iJ
performed his work, for the purpose of making a local inspection or of examining (
any person likely to be able to give information relevant to the proceedings: d
Provided that the Commissioner shall not enter any premises of any
industrial establishment except during the ordinary working hours of that 0
establishment, save with the permission of the employer or of some person
directly responsible to him for the management of the establishment. tl
36. Procedure in connection with local inspection.-(1) If the Commissioner
proposes to conduct a local inspection with a view to examining on the spot the tl '
circumstances in which an accident took place, he shall give the parties or their b
representatives notice of his intention to conduct such inspection, unless in his b
opinion the urgency of the case renders the giving of such notice impracticable. p
(2) Such notice may be given orally or in writing and, in the case of an p
employer, may be given to any person upon whom notice of a claim can be p '
served under sub-section (2) of section 10, or the representative of any such
person. tl
(3) Any party, or the representative of any party, may accompany the i1
Commissioner at a local inspection. h
(4) The Commissioner, after making a local inspection, shall note briefly in h
0
a memorandum any facts observed, and shall show the memorandum to any
party who desires to see the same, and, on payment of the prescribed fee, shall a
0
supply any party with a copy thereof.
(5) The memorandum shall form part of the record.
37. Power of summary examination.-(1) The Commissioner during a local
c
tl
inspection or at any other time, save at a formal hearing of a case pending before Sl
him, may examine summarily any person likely to be able to give information
u
relative to such case, whether such person has been or is to be called as a witness
in the case or not, and whether any or all of the parties are present or not.
d
(2) No oath shall be administered to a person examined under sub-rule (1).
cl
(3) Statements made by persons examined under sub-rule (1), if reduced to aJ
writing, shall not be signed by the person making. the statement, nor shall they, a
except as hereinafter provided, be incorporated mthe record or utilized by the sl
Commissioner for the purpose of arriving at a decision in the case. o:
(4) If a witness who has been examined under sub-rule (1) makes in evidence c
.·. any material 'statement contradicting' any statement made by 'him in such
examination and reduced to writing, the Commissioner may call his attention to tl
such statement, and shall in that case direct that the parties be furnished with the ir
relevant parfot such statementfor'l:he proposeofexamining or i::ross~examining
the witness. ·
r' ,_\ , ;
"Rule 39J

., ·····' 'I(S)Any statements or '~'ptitfeif a statement which is 'f~tnisMd tp'the parties ',,I:
I

tinder s\.:tb-hlle
· ..•.. ,.. · •r·
(4)
···--•·--
§hall q~ 'llieorp,ofCJ:ted
--··-·;·-•-"if'"''
ii} tl;te 1
hicqrq
, ... ·... _....... , . ,;-··rtlf'/'·-
.. '· · << . '· ' •,, · ·' 1 ·-~J>->·····~ , · · .. , , , , , . --~-·.

· (6) Where a case is' .s'i!ttl!!d . by ·agreement :Oetweef\ the · parties, the
. Commissioner may incorporate''in 'the recorCl any statem~iN made under sub-
. rill~' (1)' ari.d. ruliy . utili~~ )~ch' 'statement f~r th~' pllipose.',df jus'tif}!ihg his
~E~'ept:ai:\c!! ofbr r¥ftisAl"il:i'a2cepfthe Clgreeii]:ent tea'chea:: '•'' · "·' · ,, ,, . ·
·-~,-.,·--·-:i; ...·,. ·,•r:;,·( !--,~,-'-;'''-,
-'·' r-..
::,L"•'' r~·i~,--.r.-.,,.,, .. .,.· . \ 1, ?;·:- ':--\1"""''·r·.· . .-·~c,:•:•-, .... ,. ·1 1-._, .-- ·)·~--""' ..... _ ,., ., . ' .. ;~"'
·.· . .•. . ; 38, ~gr¢¢piep(tg, !lojd~ lJ,,y:' Cc:Jffitrii~sio#~t's ci&is~od~~(1). If a· .. aHy states
•In'~iiffiig his 'Willirigif~~{'tb''.~bide i?y th~ d~Cis16ri'.'9f'thi!Coillrr\if~iori,Eir, the
C;ommis~ione;r shall)nquir!! yy1a~tl!er' tl\e otWr pa~ry Is ~iilirtg to ilbii;ffh his
-_~:-. :~~~-{~~?~~·-_:·~-~',".·.,~,;. · ;_-_":' :-~:·:_- ._ ._' j:~·- ·:~J·'-:,_.~: .. t:· ·, '.'<:_.,-·.:··/'_)::~~\ '('::;·., ,'_i .,?-:,,:·' .:·: .: ·;_: :{';:···:.:.-.. -:{:; ·:· ;":.-- _,;-~ :. ~. .;i'::f: :'· ~:~:;}'-:;:_- .~.-~;.·,·_. ·.~,:. _·: _: .:.· . f i: ·::' ~ :·':.; !."' ._·:'- '
;i

; < , m ;D;th!!,c:>~er,p<JJtY a,gt~e~to abide, ]:>y the .S:Qrruhi~s~,qn,er's d,¢cisj6n, .the f<Jct
of''hltll.' re~merit shall be' recorded 'm'
_.·,:;--c;_.-l,i_---,.·:}·-§.;; !11;--:;-> ._.:·.. :.:-,·· .. ;_:<··h ·--_·:. -:_·, ··,Af: 1 :• • '
writin 'ana si · M'H' hilil: '-'!' ,., " '.·,
> -;~-:-' ·:·. · : · . ~9o'- ii:·;_.:-;~ct_:~ \._i_':,:-..;
; •••

. '(3) If the other party ddes not agree to <;lb~Fie)?Y theCqrruhissioner'sdecision,

. th!! #r§t party
; ''1~_- .• _..,_(,_ <;.t
.sha!l _not r~main
'_-····_,,-..._,:·--:'·:.·'_-!'-;.: ,_,··:~----:
uncter al} obligation so
__ ·_.' _, ,___ ._ .. -: <":\·':'~'.-':-,''••'-
to abide.
_-'h.-:.-!. - .--.:.--·._..·:.- .··. - _.,
. ·~ , a9:J>ro.:eci]lni-, :W:he,re
.-·',_,_,,_,.:_,,.,, .. , __ ,;,:.·--.".·:·
'irtdem.nitjr.cla1med
.;-\·",'_.-····...1;''1.· . ,_.','>'·- ,, ).'': )-,,:-·
~ectioJJ.j2(2),-·
u.nder,,:::----·-·.'·-.-i:··--.:.'; .(1) Wh~re
... · .. -:i· '·< .,-,,
,th~. :oppo~ite ,!?arty clC!itilS ,tha,t i£ ~omp~nsatio.ll ;is r~cqvered agaiJ:lsthim he will
• be e~titled 'i.mdei.s1,i)J7s~cfioi;t,(2)''of' ~~<:tiqh·12itq Q~ ,Vid,e@:tif~e~ Jiy" a,p~fp011•l1ot
:):J~in:l? <! il?,~fl:y:tc:>):l}~;.~.<T$,1!, ~~ :s,ft~I!; ;w~~.ll firs,(s~~i!R., !fPOft. ans~~i th,e·flpp~catlon,
i' resen~ 'a ilotice ~of. 'such' ~l~iiJi, t~ Jl\e CBfruili!lsipn~r atlc6m allied b . the
! ~testrib'~d :fe~ 'ktld •tl;l;~' Coihinissiotle':t'.:sli~ll' ther~hp'cn'1 ;lsstie 1oHce t /such

':~~~~,~wm.;~af¥'J.. '', '';/·,.';,J,: . '' . '/.'' , '' ..· . ,·. •. ·.· :. };·, · .· ·•·•· · ·•· · ·. ,. •· · .
·. ~.·. · ·•.· · ,(~)it~rY,.f?~r~~~:s~ry'ed ~i& ~ ,~q~¥ 111L4er sub-~ec~()n '(l)g~~ires !?· cof!l~st
. the apphcant's clalm fqr compensatiOn ()r .the ppposlte party's .clann to .be
.inremnified, he shall appear before the Commissioner on th~ date fixed for the
heCjrmg. of tht; case or on any. date to which llie case may be adjourned and, if
9~,so appears, ~PC\~ have allt~e rights.ofa partyto tl!e pros~~dings; in d¢fault
.·iJ(~q at?p'y.atiJ:lg.4~ .snal+ Ize qeeme<;l tp,aqr,fiit tl!e Vflli<;lity o(a~y aw,a~4 made
.~&~~s('W~ s\fifiosi~~ Jsatt)r' ~#.·fp acthiifhis,o#r\ liil~llity Win4~iiU/ifY the
.. RHPe~i1~' B.~i):Y fpr 'a,J;ly c~mrei1sati?~l.recpv~~~4 fr~Il1 :~: '"' .·., .•. . • · .· .· ! .•...·• J •' ·•.••

t~'·<';;J?ro\iided that, if'anypersonsd setvedapfear stibse~ueritlfand sati~{t~st,he

. Cointrlissionei that he was prevented by any sufficient dr~~e .~rofil 'app~arrng,
: th~ Qoininission¢rshall offer giving noticE! to the aforesaid op'P6s!te ~arty, heat
:'stil'l:'l perso)i{ aiiCI'•rrlil.yS'efaslde 6f'vaty'•ill{y awarii'mlilde <igailist such per~on
1
\lh~er'qus t'ule'ai(d Upo~ sticlitel:ffis'as'niaf'be'just · ,'1''··' · •........ •• . •·:
•.•• (3l:if anfp~r~ohsent&d 'wCftha. hdtice 1lt}ct~t '$fi~'-r,qle (1) o/h~ther ·or not he
.qesires to COJ:l.tesftheapplicant'sdaim for E&hlp~rtilation tir the opposjte partyls
'~hliift to'.be"'fflcteD:uufiea;··aalfns tKaf bell\g a. conrr~ct&i'l:ie"is' llii:liSH£ 'fi' pHndpai
· 'anlFis ·~riti'Heli th bilf•i'ndefrin:mea:.uy ir r~rsO'n. 'stan<:lihg'h'l ,hfrh in ,thefelatidn b£
a contractor iff&ffi• Whom Ute 'Wofkffian 'ctllild ·have re'C1:i\ieretFcofhpensation, he
,$h'all on'or befote the date fil(ed ·itt· the M~cti 'U.r\det sub.;rule (1) pfesertt ·aihdtiee
•· · of's'uch claim to the Commissioner accompanied by the.prescribed·'fi;ltf'and the
,Qbm,mis~ic\rters •shall thete)lp9.h 'issue t\otice'to such 'P~tsotJd.h'·Fotfil';JJ,
. .. · · •. ·' •·•.· ····• · · · · '.· ' served'!witn'i'i''hdti&•tlliaer'sub'-¥lile'(3'~'~al!sifl!~•:ro d&tlte'1>t
thi~iappliCa.t'it'.sdlai:t'rf trnclex:'stf'b•r1.f\t!. · to be
'il"lc(!')li.tit'Difii¢d.J h~ ti'l\.aU <lPF'.ea.r ~~t~t ~b~~~:~::~~:~~~:~~'jrJJ~~~;::~~;h~~.i~::- 1 ' .
I

II
I
70 The Workmen's Compensation Rules, 1924 [Rule 39

so appearing he shall be deemed to admit the validity of any award made against
the original opposite party or the person served with a notice under sub-rule (1)
and to admit his own liability to indemnify the party against whom such award
is made for any compensation recovered from him:
Provided that, if any person so served appears subsequently and satisfies the
Commissioner that he was prevented by any sufficient cause from appearing,
the Commissioner shall, after giving notice to all parties on the record, hear such
person, and may set aside or vary any award made against such person under
this rule upon such terms as may be just.
(5) In any proceeding in which a notice has been served on any person under
sub-rule (1) or sub-rule (3) the Commissioner shall, if he awards compensation,
record in his judgment a finding in respect of each of such persons, whether he I '
is or is not liable to indemnify any of the opposite parties, and shall specify the
party, if any whom he is liable to indemnify ..
40. Procedure in connected cases.-(1) Where two or more cases pending
before a Commissioner· arise out of the same accident, and any issue involved is
common to two or mor~. such cases, such cases may, so far as the evidence
bearing on such issue is concerned, be heard simultaneously.
(2) Where action is taken under sub-rule (1) the evidence bearing on the
common issue or issues shall be recorded on the record of one case, and the
Commissioner shall certify under his hand on the record on any such other case,
the extent to which the evidence so recorded applies to such other case, and the I ,I

fact that the parties to such other case had the opportunity of being present, and
if they were present, of cross-examining the witnesses. J '

41. Certain provisions of Code of Civil Procedure, 1908, to apply.-Save as

otherwise expressly provided in the Act or these Rules the following provisions
of the First Schedule to the Code of Civil Procedure, 1908, namely, those
contained in Order V, Rules 9 to 13 and 15 to 30: Order IX; Order XIII, Rules 3
to 10; Order XVI, Rules 2 to 21; Order XVII; and Order XXIII, Rules 1 and 2, shall
apply to proceedings before Commissioners, in so far as they may be applicable
thereto:
Provided that-
(a) for the purpose of facilitating the application of the said provisions 1
the Commissioner may construe them with such alterations not
affecting the substance as may be necessary or proper to adapt them
to the matter before him; ·
(b) the Commissioner may, for sufficient reasons, proceed otherwise t
than in accordance with the said provisions if he is satisfied that the I
interests of the parties will not thereby be prejudiced. I
42. Provision regarding signature of forms.-Any form other. than a receipt
for compensation, which is by these rules required to be signed by a I
Commissioner may be signed under his direction and on his behalf by any
officer subordinate t(l him appointed by him in writing for this purpose. \
43. Apportionment of compensation among dependants.-The provisions (

of this Part, except those contained in rules26,27and 39 shall, asf<1r as m_ay_~e,

apply in the case of any proceedings relating to the apportionment of
compensation among thed~pendants of a deceased workman. I
E
 .T!zf!
,. -' '
Wp(kqe'!~ (Jomp~nsatiqn ~u{es,
·.' 1\-••,- .--- .,., -, -,-,' ''': ,o•'i''?'. ,,·\'
19-N 71

PART VI
- ·- !- '' ,_'"
.. : tftANSFER ., j ~ ' - ~'
'' ' J

. . :. 44.. Tran,sfer.,fc>r r~P9rt·T(1) A, . CoJ1lllliss,~o:n.eJ:,transf~rring anY· matter· to

another Commi~.l?.~()nerfolJ r~pPr;t irl accor;dan,c~ \\'it:tt: S:llb~se¢tion, ()fse~;tion 21 m
s~~}k ~lQf!g .·fW~ t):le, ciqc~~;.rt~~ referr~4 . ~o i)}, #1<1t~~~ 7~e,qti.or;, /1'a~Irlijt ~9. such
ot!l~r. C:?:rn.rt"V~~.10r:~r '\ ~()~:.~1~· st'\~.~:ne:nt¥' t~~Jprlf\ of questiqns, fqt a:nsw~F of
the, n:J.aW~r on whj.clt ..repqr,t .;t.s. requJJ:ed. ... . .
> •,':.<··)': .. ·;1._'(.!-,-_' ',•, -", _'·-
.. .
':' ',,·;,,l.,_ ',-',.·, ',' ., . ' ' ,. , ''' ,l , ' I·'- '

•) . 11 ~6Yi'A ~qrij]):UE;~ii:Jil1lf to .:WM:t.n a c<lse is .so tf?ri~fet~ed ·for rep$:n'fshall ;fi6tbe

.J1~SJ,\1;i~eci to p:epqrt qn ?fl1Xtrflt1estiqn, of law., . . . •· .
:, ; A< ,;\~•.Transniiilsiiln. qf,rnon,ey. ''Money transmitted by. one Co:rn:rnissioner .• to
·anofh'er in accordance with sub~section (2) .bisection 21 :shall be. transmitted
egJ:iel) liy rerrrift;an~!'l tran,#et x~~eipt; <;>r by ,IT\on,~y .order or l:>y messenger, as the
Cq~s,eyjo11er ,transiT).ittir].g Jh~. ip.on~y; ID<J.,)' clirect.. • .· ,. . .·• ,

.... ·. · . ,, . : 'pAJn'Vti, ,.·:. " ·. . ;

, ,,,,'···;; •• ,, APP~l~.I~m~J:.. OF ..~7p~~$,~~TA"J:IVES .' ·' . >
•.. ··' : .
. . ·M: ~h~fi ~~:('reseAt~~i';~.$ ·¥\';l~t····h~.. ~R}'Hirlt~q--Wb,e~y ..'IllY p~rty. Jqa
· pr.gse~~/.l:lgts ~td,~r tJ:i!' ·~S~;.?~ ·l?-J;§<lr~ cgr,,I~:Pl1apl~~'tp !llake. a,n .app~<p;;;u:\c:~, tJ:l.e
Coirt:rnissioner $hall appqjpt : l$oiT!e. S,llitiJ.ble .person;., ;who·. cqns~nts ,to the
.~ppo~tmd~t t~t~prese:nf.~lfsh J?.~itf£o~:tte r~~:P9.$~~·····o{'th~:rh?seedillg., ·
. . ' 47.;Whe~· ~ew .tep/.:et!~nt~Wi',e ,tq .J;,.Y. a~point¢d.~ 'rf.,·the '¢qrowis$ioJ:Wr
~onsidefs. tl:iat th~'ifiien~$ts· 'or •ariy party. for··~hrrt\.fl tepre~~#~ati¥~; h,~~ ~.~y,n
,appoipted 11J}P~L .ruled.J.,6 ~F,e not b~i.J;}t; ~d~quately protes~yd !he SY
r~presenti'\j:iVe o( if a. person appoil;lted fiJ ~etas representative p.i~s ,or bec;qme~
incapable of acting, or otherwise ceases to act as ~p.ch,the CoriurtiE!sioner,shall
appoint in his place another person who consents to the appointm~nt. ·
, -' '" I . '- -, • ~

..... .. . . •· · .. •·PART VIIL . · ·· ·" u ·:·

''· llECtJRJ)'Q~ 1vrE1\>IORANDA :oF 'AGREEMEl'fF'·:c
. / . . .· · .· 4i(· .P.6Qii &f.''jrt~iftqtkndutn:-'-:tv:Wtitutandk ' 6f ··agr~en'ieritf :~ent' t&i 'tl:l~
•<' Coiilmissiofier'®d~f's'Ub2s'~c:ti6K'(rt)'ofsect16n•2ssliall; 111illess the ctsttltlli~'Sioner
ofhe¥}~~~·Q.ir,~ttsj 1 b~ ii1 (rupikal~)aftd 'shall b'e ,m'as' cl6s~'cgrff61'riiit)''as ·ill.~
'CifcUili'sta:nc!fsidf.'the di.ts'e 'atimn•··witJ:l.· Form'K''or:IFor'm t·'·of'Forrn. M;las Ufe'ca'se
:1).1ft}H~-~,.-,~-,-}. :,::~:_. ·' -_:~~<:,_q_:,4~:t::) _t:-~ z-',-}+·-·:;_:%:~·-r::·.~-\}:':.:,~:i\V~:~~: ~-~- \_-~c~· .:~fl t:_ .1:'\f._·:;_:~;-\:,(:_'~\--~'~/-~·:·/~{ : _:-: : , /_i:.:Jr.i_::::~_.:.;.-~::? ._ \ :~.»f~_::~·:t:?-ti-? . ~-,;~·'f>_ ·:fz - ,
49.• Procedtit~ 'WH~'f~:tq~ihth'i~~iHHI!¥·~ tio~s'''rioi' 'd6llsia~t' fhlif ':'h~'!sliliti1~
refu~b.t().'!esoi!f.·);hehi(fra,ira*~:"'''(1)i0n'rett!1V'i\igr<l:'!in'erlloran(jt'tn-\i!M.;agree:fuel1t,
the·co~s$1ciJ:1.~·r~l:faJ1)'i:m_1~ss'l:\8.'cof.i's14e'~',sA11~!.tfi'~l"e. 1ai'~.··gro\fud~'Poi'.'tefg~~g
. .lto.rl:\.cor~''th~··m~lJI:or~!:iHf¥ri;·fix. a'd~t~'fi:it fe?foram~1 ~tl:i.e·· $alli~i"ll$1:l,'$ha!l',J$&\l~''"a
··n6tice ·rn' Wtitihg:ifi 'Fol'Ifi N ..ta 'fhe'1par'tHls"c8flcefhel:l1that 'ill (\e'fafincof 'dbjecti¢ns
he prcwoses to record the memorandum on the date so· fiXeu: , · •:.; . ''
n: 3 • Pr6vm~d ~ttlie 119tge maY be cb'tfu:tttif1it'at~d oraJlJ'to atiy parties who are
1

pt~sent at the time when noticejn wtitili~(Wori:ld''dfhetwise· issue;

. (2) QnJhr (!atf !'l0flXet;i, the Co~ssioner shall teCord the II\~Il1orandum
.unless, aftet he<>ring any'•ottll~ parties'who appear and desire to be heard he
'Cqnsi.~t;!l'l·'thflti(()~ght npt to be recorded: . . . .
.. ~Provided that .th~issue of a notice under.s.ubcrl1le. (1) shall not be deel;r].ed.to
prevent the Commis$ionerf1:om refusing to record fl).e memorandum on the date
.u"·"~ even if no objection be made by any n~irhr COilCeJrne.d.
 . 72 The Workmen's -Compensabon Rules, 1924 [Rule 49

(3) If on such date the Commissigner decides that the memorandum ought
not to be recorded, he shall inform the parties present of his decision and of the
reasons therefor, and, if any party desiring the memorandum to be recorded is
not present, he shall. send information to that party in Form 0.
50. Procedure where Commissioner considers, he should refuse to record
memorandum.-(1) If, on receiving a memorandum of agreement, the
Commissioner considers that there are grounds for refusing to record the same
he shall fix a date for hearing the party or parties desiring the memorandum to
be recorded, and shall inform such party or parties and, if he thinks fit, any other
party concerned, of the date so fixed and of the grounds on which he considers
that the memorandum· should not be recorded.
(2) If the parties to be informed are not present a written notice shall be sent
to them in Form P or Form Q, as the case may be and the date fixed in such
notice shall be not less than seven day:s after the date of the issue of the same.
(3) If on the date fixed under sub-rule (1) the party or parties desiring the
memorandum to be recorded show adequate cause for proceeding to record the
same, the Commissioner may, if information has already been given to all the
parties concerned, record the agreement. If information has not been given to all
such parties, he shall proceed in accordance with rule 49.
(4) If, on the date so fixed, the Commissioner refuses to record the
memorandum, he shall send notice in Form 0 to any party who did not receive
information under sub-rule (1).
51. Pmcedure on_refusal to record memorandum.-(1) If in any case the
Commissioner refuses to record a memorandum of agreement, he shall briefly
record his reason for such refusal.
(2) If the Commissioner refuses to record a memorandum of agreement, he
shall not p<;tss any order directing the payment of any sum or amount over and
above the sum specified in the agreement, unless opportunity has been given to
the party liable to pay such sum to show cause why it should not be paid.
(3) where the agreement is for the redemption of half-monthly payments by
the payments of a _lump sum, and the Commissioner considers the
memorandum of agreement should not be recorded by reason of the inadequacy
• of the amount of such sum as filed in the agreement he shall record his estimate
of the probable duration of the disablement of the workman.
__ 52. Registration of memorandum accepted for record.-In recording a
memorandum/of agreement, the Commissioner shall cause the same to .be
entered in a register in Form R and shall cause an endorsement to be entered
under his· signature on a copy of the memorandum to be retained by him in the
following terms, namely:-
"Thi!> memorandum of agreement bearing Serial No ............... of 20..... in
the register has been recorded this ................... day of... .... .
(
(Signature) ... ::.,: .................... ;...... ;.
Commissioner."
 73

FORM A
\ [See '!tile '6 (l)l ··
\. . ···'" ", ·'·' '.·.';.•f-1'' '·' ".'-' • • . . , .• -.' ···- ·-... "
DEPOSIT OF ebM:PENSATTON'FOR :FATAL ACCIDENT
[Sectl'on8i(1) ·6f•the:Wotkmen's Coiiipensa'titin Act, 1923] ·
:compensation amounting toRs .. :.:;,·..• :H,).is hereby presented for deposit in!respect of
injuries resulting in the death of the workman, wh()se particulars are gi.ven b,~!()J:V/tWhich
occU:tted ·ori ........................ · ·. .. · · ·
· -· :' ;:;_\_t ·:·-· ''<"'···.
··•-,-~·::.:·~;"·~:;:·._; ~-"-.
·: :··, ,,. .._..;
,~·•;'<'!'~ ,-
'.<-,-;.'f:,c·~~~~;,~·-·-~--· ~-·";'; ~
•-·_'<"''l'C·"-"'-:·:T-:-""7 '' :---:-~~-~-- ·•-•>~-<t-i~~< "7-'•:-~·-

. Name ............ ;•...........

(H:il~bartd's ri~me in case of rn;irried woman and widow.) .•:

··c~~td.:.:.:..........:....... ·
LOcal· addreSs ................................. ,-.. "' t'

Nrmanent address ........ H.HH,,H, ... ::H .. ;•H·

His/Hetmonthly wagesar~ .es~~t~datRs......,,.:,······•;· He/ She was over/ under the
age 6fl5 yeafsat the tithe of his/he~ death.· ... ·.' .·.•·· · ' ·.. . . .··
2. The said worJ4an had; prior to the date ofhis/het death, received theJollowing
. payrnents~namely:~ · .,
Rs. •HoOHH;H.,,H pn '''"'""""'"';"Ho Rs . ......... :c ..... ()l:t: ',',;,'.'.',.''.".'."'·''·',',".',"," ., ' • ,; i •

.:: ::::::;::::::::>~~ .::::::::::::;::::.::::::. :: :::::::::::::::: ~~•. ::::::::::·:(:::::~;r:· . .i··· ,...

,~moWlting!n<lA.tp Rs .. ,, .. ,, .. ,.. ,.. <······· •'··· ·..·. . , ,.· . '· ......, ·./•·.····,.• ,•
3. An adv~ce '()fRs ...,. .. :: .... :: has been "~~d~' o'rt' acco~t' ~f .cmnpensati~n to
"., .............. being his/herdepe.hdant. .·.. ·.... · .... , . ..., ' ·.· :·. . ..·
4. *I do not ·desire to be made a party to· theproceedings for distrlbutioll. of the
aforesai<:l compensation. · · · ' · · '
Dated .. ,.................. . ..... ;......... ,•.
_, .·. .· .·. , . ·. . . . _ . . .· . Employer.
*An employer' desiring to be made..a party to the proceedings should strike otit the
,words "do
"f'-"''. ,-'
riof~/
' .·..
.
·,
· .. ·. · ·
. · · FOR!\1 AA. .
. .. . • · . ' · ·. . [See rrlle 1l (l)l . · · .'
. bl:li'qsrr,OF c(J¥t>ENS.\'I'I,SJ~1 jp~ NON-FATAL A.ccuiENt•"ro ;
.· A WOMAN OR PER.S,~N' {fNIJER LEGA'L DISABILITY . . ·.
.· .. ·.. ;· . ·. . . [S~ctio~ 8 (1) of fhe W~~kfu'eh'~ Compensatio!l Act, i923] ·. . · . . .
· . :c§tr/p¢li~~t{6!{·~~9tlhillfi.:f6''ij~;.:.~i':,,;!ft{'j~·j:{~~~b~ 'fi~~~~~(~d··ioi~ep6~\'t.'ifl%f~spect ·--
11
.f , ·o '\r·,'o-_':.-_J-; '.::.r:<f'-·t<''··.; '·· '<.:d" i b··:' :· '-': _:_~_- ..:c~·( :_ .--~, ::: -,<-~i>f:: -·,;~:·_";.\t,;h. -'';)l"4 ·> ,!;\" t:· -,·_, ,__-]:·,_J'V,;·<r.f'l;\' /-\ _:;) 1.. ,,,,\}:'\·X;;'.~ 20
0. mJUnes. ~Us awe > .)'· .. ·~:·"';·;··':,"·"': ~eSly.J1lg a ............................. on ...... ;............ .
resulting in th~}osspf(te~nporaryrdi~il~l~ft[eiiti l:tl'il'/Her morHhly wages>are estimated at
1:~· ,,.:., ....•....;.•~e/Sl).e was,?Yefi~M.~Jl).e<Jge ~~ \l,§,y~,a~,~.llt·tl.\!l •. ffm~,ofth~,jl,C~ic,lent. 1

.· ~: The s~1~ injured •\:Vorknlan has prior tO') th~ .. d~te. :of the (ieposit r~~eiv:'ed the .!
folloWing half-· monthly '.PaYJll.~nts,riamely:..:... · r. ' : n
<Rs. .: ............ ·.on ., .•... :·:................. · . Rs. • ............. on ...................... ..
.. •.· .·.·•.·.:.'·. .•·..•·•.· ·.·.•· .·.·.·.:_.•.•. • 'on· ·
Rs
. .. . .. - . , ............
· .. ...
;· '·..-;.-.· " .-.-•..-
Rs.''.· .••••••••••··••• ·.o··n··
., ._ . .·-x-.~!·:--!'· ....... ~ ...-... :on · ............ .. ......
~· ~ ~ ' Rs. .............. on .............. .........
- ~

.•.• ...... ·-·~·-:~ .....~ ~ _:, _

____,-~-

Dated .............. · Employer.

 ,.-··- . - -~ ...:;_ .

74 The Workmen's Compensation Rules, 1824 [Form B F

FORM B
(See rule 6)
RECEIPT FOR COMPENSATION
[Deposited under section 8 (1) of the Workmen's Compensation Act, 1923]
Book No. .................................. Receipt No .............. .
Register No ............. ..
Depositor ............................. Deceased or injured workman ........................... ..
Date of deposit ........... .
Sum deposited Rs ...............
··························
Commissioner.

FORM C
(See rule 6)
STATEMENT OF DISBURSEMENTS
[Section 8 (4) of the Workmen's Compensation Act, 1923]
Serial. No ............ ..
Depositor ..................................... ..
Date ..................... 20 ......... .
Amount deposited ...................... .
Amount deducted and repaid to the employer tmder the proviso to section 8 (1) ........
Funeral expenses paid .......... ..
Compensation paid to the following dependants :
Name Relationship

Total-
Dated .:.............. ..
Commissioner.

FORM D
. __ (See rule 9)
DEPOSIT OF COMPENSATION FOR NON-FATAL ACCIDENTS, OTHER
THAN TO A WOMAN OR PERSON UNDER LEGAL DISABILITY
[Section 8 (2) of the Workmen's Compensation Act, 1923)
Compensation amounting to Rs ............... is hereby presented for deposit in respect
of permanent/temporary injuries sustained by .................. residing at ....................... which
·I
occcurred on................20 ... ..
\

Dated ............. . ................. .

Employer.
- -- -··-·- ·~-- ....... ~-. -.--- -----.
 I '·j' '''
',: ,··_:
•'J
, I-_

FORME ';. \ •'"l., I

,, q

, .. ,, , . . \See r;~le ,9) ,

RECEIPT FqR ~QMPENSATION
[Deposited under section 8 (2) of the Workmen's Compensation Act;·1923]'
·. Book·No. ·'··•··'·''··• · Receipt No .... ,.,;;,,,;,, ,, , · ; ~ ·.·1 • ·
Register No ................ .
Depositor............................. .
lh favour of ....................... .
pa~ of depqsit ............. .
. ?1.\Pl. deposited;&>·,:··"''"""' ...........................
-~- - • ''•-Co' ";-' • -

Commiss~oner.

•, iidRM'EE I ''·, •...

--_, ~-. '

. I '(sd\tile li) '
REPQRT '(jp FATAL ACCIDENTS

............ ......
[,-
;
'I
..........,......... \. ,
II
Sir, ·. · ·.
.
, ..· . · · . .
1; , ,, ) ,n~~~.' .trcc. ~?~?W tR ,submit .the, follq~~$. rer9it 'of ·~I a~ci~~t' whi~l ()CCurred
1
I
1 •
I
'fff~i'<fi~~i6f~W!~~~d~hJ~X7~·g·;~$~8lD~~ot~~i~t!df~:~)g~!w::~~~t~l~e~
--~~~-C~:d_~-:_;_,(·-:. . _. _:_-;::.:<,<···_:·-_··. · _: -~:_:-. ·· ~ r,: -~ ·r;:i, :·: ·__ -·-·: •___ .__ . __,. .•. <. ·<.--···- .___ ::-· .· -_-_·-- -_,.-'·--·
• ,,•,o '2: The drdiinstances a:tfending the death of the workffiml./workmen were lll~ lll)der :
(a.) Tim~ 9£ the. accident ., .·. 1
·· · ···. '

o?J i:>r~~e '\.vhe;~' the accident occurred. .

(~) Manner in \Vhich deceased was/were employed at time
" (d) Cause of the accident
(e) Any other relevant particulars
lhaveetc.
(Signature and designation of pt?rson,mll;)9ng th~ report.)
/
Statement '·
Sex Age ·Nature of Full postal
·ell\:ployment .,·., f'address·
---·-·----~~~~----------------~~~~~~~--------~--~

:(; ~.q,
· ,.,,\ :ro(Sel!r!lile•:20): '·' i·
APPLICATION FOR COMPENSATION BYWORKMAN
To ;, }.

-•••••• ·.-. ·-: ••••• .·.: ·- ~-· ~. :· . . . . . . . . . . . . . ·:· 0 •••• •••••• 0 .-~~-'.-,"~;:i/1 (: i·:- ••-..• .••_-. . .
. • • • • .-•.. i .... •• ~. ·~ •• -' •;· ..•.•• '\': ·~ ·.:·· ·.·_: . .••••.• ~ ._. ',•,· _.•• ~· ....... ·-~ .•_.. ..
- - - _...... res1·d···-_--
............... mg af;/(":;;·,t'r'::,;)\:_i,.;;::~(('.fia ..'- ·1· · ·.t··
... ,......,........... ,.,. pp1c<Ul, ,,,, ..__.,, .. ·, -.,
Versus
.... ,................ residU:g _at .......................... opposite party.
 :.;;;;--,_

Form'
76 The Workmen's/Compensatlon Rules, 1924 [Form F

It
It is hereby submitted that-
(1) the applicant, a workman employed by (a contractor with) the opposite party on
the .............. day of .............. 20 ....., received personal injury by accident arising out of and
in the course of his employment.
· The cause of the injury was (here insert briefly in ordinary language the cause of the
injury) ................................................................................................................................................. .

(2) The applicant sustained the following injuries, namely:-

(3) The monthly wages of the applicant amounts to Rs ............. .

The applicant is over /under the age of 15 years.
*(4) (a) Notice of the accident was served on the .............. day of ....................... .
(b) Notice was served as soon as practicable.
(c) Notice of the accident was not served (in due time) by reason of

(5) 'The applicant is accordingly entitled to receive-

(a) half-monthly payment of Rs ....... from the ............ day of 20 ..... to ................. .
(b) a lump sum payment of Rs ......... . 0
(6) The applicant has taken the following steps to secure a settlement by agreement, [
namely .................................but it has proved impossible to settle the questions in dispute
because .................................................................................................................................. .
* You are therefore requested to determine the following questions in dispute,
namely:-·
(a) whether the applicant is a workman witlcin the meaning of the Act;
(b) whether the accident arose out of or in the course of the applicant's
employment;
(c) whether the amount of compensation claimed is due, or any part of that
amount;
(d) whether the opposition party is liable to pay such compensation as is due;
(e) etc. (as required).
Dated ....................... .
Applicant.
*Strike out the clauses which are not applicable.

FORM G
(See rule 20)
APPLICATION FOR ORDER TO DEPOSIT COMPENSATION
To
The Commissioner for Workmen's Compensation, ........................................................ .
• • •• ••••••..• •• • ••• . • • • • •• .. ,·_. ;'~· .. ',; ,'/,,.,;. ,;, "' •. •.· ••• 't'' ..... .............................·....................................................... ' .••. 0 • • •

........................ residing at ..... ;.........................;; applicant,

- --- ··-~~-. Versus
...................... residing at;;;·;,"·"···••oo••·············:: opposite party. ·--~-·--·'--.--
=orm,J-Jl
I :·!'-;-·.
77

It is.hereby submitted
r . .
that-
..
..
, .. ' ·.·-
. ,
. ., ,,
-' "'
.<, .....·. .
,_, . ,.. .t., ....

. . ,~j,},,;:·.·:n:n;'>';';::,;::::.;i;'l;~8?~~r:t, ~!J:Lployfd ~X ,(a ,co,r:ttmdol" ,'Yitnl •. ~.~ opposi~e :party

.,:,..... ;. O.n·. ·.
' ·. ,,. ·arismg'.'out m
.
··e...'.. ...' ,..,,·,·,·:cit ~.~ .·.·, .'.:. . . 'd.'.'~yof:••·;::··;:,
. .·:.; ·..land 1
itt ·fhe coursl:!·,··;~0;··.;·:< r·e'C~lV·····e·.·d.· p.. e.,r,s.pl'\a.
of his employment 1 ffiJ1fi)'········b·y··,\l~C
restllting in his d~ath. . l·d·.·.en
. . t.
on
the .... ,...:., ...... :.<;iayot .. ,....... ,.... 20.....,. The cause of ,the injury was (here lrisert
' ,} briefly in. ,otd.iriary ' langtiage the ' cause of . the injury)
'.:: .. ·' . . '. ,.; :.:,,:. :.;.: :· ., ........:....... :·:: :.............. :.... ·,· .......... ;.:... '·' ..... ·: t........,.... '... .
.. ; ~0 •••• ·~· • • • • • ~.-.-.-.-~.- • • • • • • • • • • . • •. . . . . . . . . . . . . ; . . . . . . . . . . . . .- . . . . . . . . . 0 • • • • • • • • • 0 . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . ; . . . . . . . . . . . . . . . . . . . .
·-•·· ,,_. -"'-' ·-·~'~·- ·-· · ·'."o'w•·••·,...,.,-.~·..;"'-~-·-··~•·~._,. • ~..,;,- •·-~~'""'·'·-·•-".,_.--.~•- ''''""~- -• ~--.•••'=-=- •--·· -• "~····--~•• > ~--, ·--~~.,~ . . ,.,~·;or " ~·<• "'''•"' '-•-~~- -, •--- -~·

The ~pplicant(s) is/are dependant(s) of the deceased workman being his

........ .
. ' '
;
.,
.,; ..........._.. '

(cy)' th~ J:D.<i,f\thlY wag~s of tl:\e d,eg~.\1-ey~d,.;<Wtouhts to Rs ..,........... The deceased was
.,,;rf,:-y_:f:. over!uttd,er
;;:·.,,·_. ;-.";," • the· age
.... .-,,._\'\~·:·'
ofl$ years at the time: of.his death. ·
: .... _,_,,/, _('_'-,f.:' ... '.\-'.·-·· . . (•~ .. ,-.. ,_ _- . ·
.
"''
., . •-. .,•
, ~(l),,;1(a) No!i9~o#ftlt!,,~cp~q~q\,was ~ery~ci ar:t the ·"''''''"·'tday qf ................•.·.··"·"" .
;;,•i(b) NpQ.cerw.~.s•sf)rved;as so6r:as;practicable.· :.· •' · · •• '··•·
·t (c) Notice •l:Jfth:e' acdderit was·>.not set'ved (ill dhe time) by reason
·,J:'' ·_::~,:·_:.i_~/6£-J~. _.:;_-~-.:rt-.;~_~·:·:..::}::·-~·::·~~--;;._;·'·\~.·_:•:···... >_-;_. ·.--· ... _.__ =·.· .-____ . _. :·=· . =·, - ·____ · ,_- ___ . h __..... , _. __ : _ . . ___ _.. _ .-- ..-. _... -_ ,.__ _. __ · ...... _

'·ts)' 1J:e d.¢ce~~@ B~f()t~ lUs· d,ea~ !ecelV:e.d ~s cl>mpensafio~ thi'bra1 'sifut h£
············r·~~~i-IJ£~~~. 7~~~:ijp~f~):,~i:r:~t·~c~~~~~~tf.~~~~~~··t~!;e~t'J~;~~!::;~ ..
· . ·.. You a~e tJ:terefore requested, tq awatd.t() tlj'e appli.can.t the said compensation or ~l:lYr
Jthitr compensilt:lon to which he may be entitled: . . . ' ' ....
6ateii. ::~~;:::,::~:.'.~ ..•. · · ..................
' . - ";:"';>-.i.'f, __,-"·:
Applicant.
"Strike out the clauses which are not p,pp\.i.f<!l;Jl<;: ·
FbRM}I ' ~

. .· (See rule 20) . .· ..·

· , APPLiCATidN.FO:R CbM:MUJ<\TtC>N •. ·.
. ....
;·':-,}~< .:.·.-_..,.'_ ·:,·:-'._-' ·: ·. ' _ ,.i<_-:.'··_..-._.,.,U".:·:=··:'f'>''::y.:-:;":>-~::'·.:;~:"-'._/_--- __-;:-,_:--:~-;·_>. .-.
' . ,,o·.
, i__ :..r·
··_i',;'(.:,_._,·,·/_:f;::_;_. · [l]:qc!!Jr se99op 7 gLtl.}~·yYptJ,<mEfl): ~ ~o)?;iB~nsa~ip:t)jt\ct,r192fll · · ' ·· ·
ro.:_-/:i-i,;;:s.~.: . '!· ,:"/ .~)-~:,;~ ,.,,.,_};;~r '-, r•' -,::·. ''':u;;
)l:. !fhe·Go.rrtmissi~rter ··for Workm$.'~ GO.rl'\fieii:sfl.nori:/ ·.·, . . ·•· ·· ·: •· •· ·

.,W";~~~:::1~\~M;~;::~·:::;~::
, ·,__ ~ +..
.~·••••
: : : :·:;: :: ~: :·: ':'~: :~ :~; ~; ;: ;:~; i~ ~;~;~ · :. t.'.··., .i·,r. .,.. .
~-.··~· ,·;.•,residiri.g . . at: .,:.-.. ,..... ::\ .';·); ...~. ,. ,_.......~·.ap:p,li(:ant,-::r--~ ~'-'·}., h
' ,,;::

:·; ~".:.:;!.~...·~:.:~ :~.~ :...:·:.~~t~~~,,~:r~~~. . ~.:~.'.~,;{.'.)\;~;:;;:PP:stte p~r~.; .

j • ......
1

.. . . ,(ltis):te~eby ~~~:rnittec!lliat 7 . ·. .. . 1 n;:r; . I

I
·''"'"'(•1) ·'Tl:ieapplicani;opposite· ~arty .has been .in.respect ofhalf,monthly ·paylller:ts ,,
.,from ·.,; ...... ,.. ;.. ,, .... ,.. tq .. ,.......... ,.•••,.... in .xespect of .teJl1poraty .disablement by
ets~d!Jnt ariskg o~tof and.if~'t~C\tlfs.e of hi~ ~n1Pl.9ym~nt. . ·• . . ,
(~) 1;{ne applicar:tt .is de~u·qus that ~thl;l tight to r.e~eiye half;monthly payinents •··
i.'
$llO.l.lld be,rede11m~Q,:,; , , , · ,~,.
(3).... (a)·· Tl.}eqppoE;it~ partY is 'clll1V:illing to agi~eto.th,!; ..~;e,d~.fl}pfi9n qf ~~~ r[gJ;lt to
?zri'~' -:>'. -,JI!~-'-:t:-'.:_~,L:.}2f~~~~ .:t~'~M:~~p~ffiit,:J?-_~)f#tel}t~·· .· '/' )f J.]. "~,j:. _:·,~;'-t:iA~t;f!.~·.:',i;-::"':?~·-;·:~:,:.;h:~:?~--~: .f~ ,:;'·.;_:~~;Y. ,;r.i:"_-': ; _
re ii'rdlii.'''the inimtor wluch'fue'
,':_

•:rH ' . ' 'hl) . t':fui 'artiEJs'haVe been un'ableto a ee

,, '"" ''' tv '' .ri•·mRft; W~~l.v{'ha.l1-IT16riilif' ' a ~iits stow.<:ftg·;~a~~iri~::r · "' .· '"u'
;',;};~;,~l't;?'::~i(·~:1~fil.l£ 2"w~';:;' ·. •::.· ;;·:·•' ';~:'~~[',:'' x:;, .:·.· . ;;'''1'- 'i·l\''' ;:.w;;; un.;. ''·
78 The Workmen's Compensation Rules, 1924 [Form H

You are therefore requested to pass orders -

(a) directing tha.t the right to receive half-monthly, payments should be redeemed,
(b) fixing a sum for the redemption of the right to receive half-monthly payments.
Dated .................... .. ............... .
Applicant.

FORM J
(See rule 39)
NOTICE
Whereas a claim for compensation has been made by...................... applicant,
against........................ and the said........................ has claimed that you are liable under
section 12 (2) of the Workmen's Compensation Act, 1923, to indemnify him against any
compensation which he may be liable to pay in respect of the aforesaid claim, you are
hereby informed that you may appear before me on ...................... and contest the claim
for compensation made by the said applicant or the claim for indemnity made by the
opposite party. In default of your appearance you will be deemed to admit the validity
of any award made against the opposite party and your liability to inderrmify the
opposite party for any compensation recovered from him.
Dated .................. .
Commissioner.

FORM JJ
(See rule 39)
NOTICE
Whereas a claim for compensation has been made by ........................ applicant,
against ........................ and the said........................ has claimed that.. ...................... is liable
under section 12(2) of the Workmen's Compensation Act, 1923, to indemnify him against
any compensation which he may be liable to pay in respect of the aforesaid claim, and
whereas the said ........................ on notice served has claimed that you ........................ stand
to him in the relation of a contractor from whom the applicant ........................ could have
recovered compensation you are hereby informed that you may appear before me .
on ............. ,.......... on contest the claim for compensation made by the said applicant or the
claim for indemnity made by the opposite party ........................ In default of your
appearance you will be deemed to admit the validity of any award made against the
opposite party........................ and your liability to indemnify the opposite party
........................ for any compensation recovered from him.
Dated ....................... .
Commissioner.

FORM K
(See rule 48)
MEMORANDUM OF AGREEMENT
It is hereby ,submitted that on the ........... day of .............. 20 ..... P"Crsonal injury was .
caused to .. ,;,-,\·:';;,,·; .. :........ residingat.. .............................. by accident arising out of and in the
course of employment in ........................ The said injury has resulted in temporary
disablement to the said workman whereby it is estimated that he will be prevented from
earriirig moretniill of his pievious/ai-ry wage for-a period 61.::-::::: .. "months. The-said
workman has been in receipt of half-monthly payments which have continued from the
 Form L] The Workmen's Compensation Rules, 1924 79

........... day o£... ........ 20 ..... until the ........... day o£... ........ 20 ..... amounting to Rs. ........... in
all. The said workmen's monthly wa~es are estimated at Rs ........... The workman is over
the age of 15 years/will reach the age of 15 years on ................... .
It is further submitted that .................... the employer of said workman has agreed to
pay, and the said workman has agreed to accept, the sum of Rs ........... in. full settlement
of all and every claim under the Workmen's Compensation Act, 1923, in respect of all
disablement of a temporary nature arising out of the said accident, whether now or
hereafter to become manifest. It is, therefore, requested that this memorandum be duly
recorded.
Dated................ .
Signature of employer. ............................. .
Witness ....................... .
Signature of workman ............................. .
Witness ....................... .
Note.-An application to register an agreement can be presented Uf1.der the
signature of one party, provided that the other party has agreed to the terms. But both
signatures should be appended, whenever possible.
Receipt to be filled in when the money has actually been paid
In accordance with the above agreement, I have this day received the sum of
Rs.
Revenue
Stamp
......... ,.............. Workman.
Dated ........................ . i
The money has been paid and this receipt signed in my presence. I,
I-

........................Witness.
Note.-This form may be varied to suit special cases, e.g., injury by occupational
diseases, agreement when workman is m1der legal disability, etc.

FORM L
(See rule 48)
MEMORANDUM ON AGREEMENT
It is hereby submitted that on the ............. day of .................... 20 ..... personal injury
was caused to ........................ residing at ................................by accident arising out of and
in the course of his employment in ............ The said injury has resulted in permanent
disablement to the said workman of-the following nature, namely:-
.......................................................................................................................................................
,

The said workman's monthly wages are estimated at Rs .............. ..

The workman is over the age of 15 years/will reach the age of 15 years on
........................ The said workman has, prior to the ·date of this agreement received the
following payments namely:-
Rs ................ on ......................... Rs ............. . ..on
Rs . .:.......... :.. on.........................Rs. :............ ("'C\:':':'\)n
Rs ................ on ......................... Rs. ............. on ....................... .

. __ ~ _pay,r::J~~e~aldb~0~~~ath~i ..i~r~~~e-ffiF'i~:~~f~{·o~f~t~~h~eeisS:: ~o~~~~ .~~.~.~~r:~~ ______ ---·-·

settlement of all and every claim under the Compensation Act, 1923, in
 The Workmen's Compensation Rules, 1924 [Form L
80

respect of the disablement stated above and all disablement now 1!1-atufest. It is, therefore,
requested that this memorandum be duly recorded. ..
Dated .................. .
Signature of employer ...................... ..
Witness ...................... ..
Signature of workman ...................... ..
Witness ...................... ..
Note.-An application to register an agreement can be presented under the signature
of one party, provided that the other party has agreed to the terms. But both signatures
should be appended, whenever possible.
Receipt to be filled in when the money has actually been paid
In accordance with the above agreement, I have this day received the sum of Rs .....
Revenue
Stamp .
.................... Workman.
Dated ......................... .
The money has been paid and this receipt signed in my presence .
....................... Witness.
N ote.-This form may be varied to suit special cases, e.g., injury by occupational
disease, agreement when workman is under legal disability, etc.

FORM M
(See rule 48)
MEMORANDUM OF AGREEMENT
It is hereby submitted that on the ............... day of ...... ,......... 20 ..... personal injury was
caused to ........................ residing at ................................ by accident arising out of and in
the course of employment in ....................... The said injury has resulted in temporary
disablement to the said workman, who is at present in receipt of wages amounting to Rs .
........................ per month/ no wages. The said workman's monthly wages prior to the
accident are estimated ,at Rs ............ The workman is subject to a legal disability by
reason of., ................................................................................................................. .

It is fmther subnUtted that ........................., the employer of the workman has agreed
to pay and ........................ on behalf of the said workman has agreed to accept half-
monthly payments at the rate of Rs. .. ............ for the period of the said temporary
disablement. This agreement is subject to the condition that the amount of the half-
monthly payments may be varied in accordance with the provisions of the said Act, on
account of an alteration in the earningsof the said workman during disablement. It is
further stipulated that all rights of commutation under section 7 of the said Act are
unaffected by this agreements. It is, therefore, requested that this memorandum be duly
recorded.
Dated .......................... .
Signature of employer.
Witness ....................... .
Signature of workman ...................... ..
Witness ...................... ..
Note.-An application . to. register an agreel1l~l1t _can be. presented under the
signature of one ·party, provided that the other has agreed to the terms. But both
signatures should be appended, whenever po:ssilJle.
 Form P] The Workmen's Compensation Rules, 1924 81

Receipt to /Je filled in when the money has actually been paid
In accordance with the above agreement, I have this day received the sum of Rs .......
Revenue
Stamp ..................... Workman.

I '

Dated
The money has been paid and this receipt signed in my presence .
...................................
. Witness .
Note.-This form may be varied to suit special cases, e.g., injury by occupational
disease, etc.

FORM N
(See rule 49)
· Whereas an ag~eement to pay compensation is said to have been reached between
........................ and ........................ and whereas ........................ has/have applied for
registration of the agreement tmder section 28 of the Workmen's Compensation Act, 1923,
notice is hereby given that the said agreement will be taken into consideration on
............. 20 .... , and that any objections to the registration of the said agreement should be
made on that date. In the absence of valid objections it is my intention to proceed to the
registration of the agreement.
Dated ................. ..
Commissioner.

FORM 0
(See rules 49 and 50)
Take notice that registration of the agreement to pay compensation is said to have
been reached between you ......................... and ........................ on the ................. day
o£.. ............... 20 .... has been refused for the following reasons, namely:-

.................................. ............................................. ........................................ .............

" " ~ \'''' ................ .
Dated .................. ..
Commissioner.

FORM P
(See rule 50)
Whereas an agreement to pay compensation is said to have been reachFd between
........................ and ........................ and whereas ........................ has/have applied for
registration of the agreement under section 28 of the Workmen's Compensation Act, 1923,
and whereas it appears to me that the said agreement ought not to be registered for the
following reasons, namely:-

an opportunity will be afforded to your showing of cause on .................. 20 ....., why the
~aid agreement should, ,be registe~ed. If no a,~teg\!,a,!~, cause is shown on J;hat date
· registration of the agreement will be refused. ,'"'' ,,-""'"''~" ,,,,
Dated.................. .. ....................... .
_Commissioner.
 ..... :....--.~·-··-
-"""'-:

82 The Workmen's Compensation Rules, 1924 [Form Q

FORM Q
(See rule 50)
Whereas an agreement to pay compensation is said to nave been reached between
...... :................. and ........................ and whereas ........................ has/have applied for
· registration of the agreement under section 28 of the Workman's Compensation Act,
1923, and whereas it appears to me that the said agreement ought not to be registered for
the following reasons, namely:-

an opportunity will be afforded to the said ................................ of showing cause on

.................... 20..... why the said agreement should be registered. Any representation which
you have to make with regard to the said agreement should be made on that date. If
adequate cause is then shown, the agreement may be registered.
Dated ....................... .
Commissioner.

FORM R
(See rule 52)
REGISTER OF AGREEMENTS FOR THE YEAR 20 ............ .
Reference
Serial Date of Date of Employer Workman Initials of to orders
number agreement Registration Commiss- rectifying
ioner the register

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