Approved form AF2002-135

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 10A
(see r 19A)
Certificate of service
[Heading as in request for arbitration]
I, (full name) (occupation) of			      in the Australian Capital Territory, certify that today I served			with		by—
	*(a)	leaving a copy of it at (address).
	*(b)	sending a copy of it by prepaid mail addressed to		.
Dated:						
....................................
(signature)
*Delete whichever is inapplicable

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