Approved form AF2002-134

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 10
(see r 19)
Affidavit of service
[Heading as in Request for arbitration]
I, (full name) (occupation) of			in the Australian Capital Territory, being duly sworn make oath and say as follows:
1	I am over 16 years old.
2	I did on			day of			20	       , duly serve the abovenamed			with the			annexed and marked			   ‘A’ by delivering a true copy of it to him or her (personally or otherwise) at 
Sworn at 			this			day of		  20   .
Before me—

Endnotes
1	This form was originally in the Workers Compensation Rules 1938, schedule 1.  Under amendments made by the Legislation (Consequential Amendments) Act 2001, the form was omitted from the rules and became a form approved under the rules, rule 89 (see amdt 1.2805, amdt 1.2807).
2	This republication includes amendments made under the Legislation Act 2001, part 11.3 (Editorial changes).

©  Australian Capital Territory 2002