DCEC          / 2024

IN THE DISTRICT COURT OF THE

JURISDICTION_STATE

EMPLOYEES' COMPENSATION CASE NO.             OF 2024

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IN THE MATTER OF AN APPLICATION BETWEEN:-

PARTY_1_NAME	Applicant
and
PARTY_2_NAME	Respondent

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APPLICATION

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1. (a) On DOA, a personal injury arising out of and in the course of employment was caused by accident to the Applicant, an employee employed by the Respondent.

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

2. 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.

3. Particulars are as follows: –

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