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
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
- Bank account and savings
- Other assets
- 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)
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