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Application for Employees' Compensation

Work Injury

Application for Employee's Compensation. A personal injury arose out of and in the course of employment which was caused by accident to the Applicant, an employee employed by the Respondent.

At all material times the Respondent was an employer within the meaning of the laws.

An application under the Ordinance is hereby made by the Applicant for the following relief or order -

(a) Compensation under sections 9, 9(1A), 10 & 10A of the Ordinance;

(b) Interest; and

(c) Costs

Immediately after the Accident the Applicant suffered from a physical injury and was then admitted to the Accident and Emergency Department.

This document also includes a statement of truth and a notice to respondent.

The document also includes Form 16(C) - Admission (unliquidated amount). The form includes:

- Response to claim

- How are you going to pay the amount you have admitted?

- Personal details

- Dependants

- Employment

- Bank account and savings

- Residence

- Income

- Other assets

- Expenses

- Liabilities (for arrears only)

- Firm, company or corporation

- Assets of firm, company or corporation (eg property, plant and equipment, inventories, goodwill and other intangible assets, loans and receivables, bank balances and cash etc)

- Liabilities of firm, company or corporation (eg trade payables, tax payables, other payables, bank loans, other borrowings and others)

How to tailor this document for your need?

1. Create Document: Click on “Create document” button and fill in the details of the parties. You can click the “Fill with Member’s Information” button to complete the party’s information with your personal or business information saved to your account.
2. Please fill in any additional information by following the step-by-step guide on the left hand side of the preview document and click the “Next” button.
3. When you are done, click the “Get Document” button and you can download the document in Word or PDF format.
4. Please get all parties to review the document carefully and make any final modifications to
ensure that the details are correct before signing the document. Each party should have a copy of the executed document.

employee's compensation
personal injury
work injury

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